Provider Demographics
NPI:1184402307
Name:MILFORD, GRACE
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:MILFORD
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 1:8734 NORCROSS DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-1817
Mailing Address - Country:US
Mailing Address - Phone:314-775-5161
Mailing Address - Fax:
Practice Address - Street 1:11011 GRAVOIS RD
Practice Address - Street 2:
Practice Address - City:SAPPINGTON
Practice Address - State:MO
Practice Address - Zip Code:63126-3601
Practice Address - Country:US
Practice Address - Phone:314-729-2460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021037260235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist