Provider Demographics
NPI:1134735970
Name:PRIETO, GRACE MARIE
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:MARIE
Last Name:PRIETO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 E SHERIDAN AVE APT 1126
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-6704
Mailing Address - Country:US
Mailing Address - Phone:787-226-6929
Mailing Address - Fax:
Practice Address - Street 1:505 E SHERIDAN AVE APT 1126
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-6704
Practice Address - Country:US
Practice Address - Phone:787-226-6929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4034235Z00000X
CA30276235Z00000X
OK5265235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist