Provider Demographics
NPI:1083580468
Name:ROST, GRACE JULES (RBT)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:JULES
Last Name:ROST
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44463 BAYVIEW AVE APT 31213
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-7343
Mailing Address - Country:US
Mailing Address - Phone:248-525-1298
Mailing Address - Fax:
Practice Address - Street 1:23800 NORTHWESTERN HWY STE 190L
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-7740
Practice Address - Country:US
Practice Address - Phone:734-934-1322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-14
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRBT-24-338647106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician