Provider Demographics
NPI:1184763054
Name:GRACCO, LINDA CAROL (PHD CCCSLP)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:CAROL
Last Name:GRACCO
Suffix:
Gender:F
Credentials:PHD CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:652 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2719
Mailing Address - Country:US
Mailing Address - Phone:203-453-5083
Mailing Address - Fax:203-453-0639
Practice Address - Street 1:652 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2719
Practice Address - Country:US
Practice Address - Phone:203-453-5083
Practice Address - Fax:203-453-0639
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001935235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT01088100OtherASHA CERTIFICATION NUMBER
CT001935OtherCONNECTICUT STATE LICENSE