Provider Demographics
NPI:1376838284
Name:VAN-NIEL, GRACE JOSEFA
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:JOSEFA
Last Name:VAN-NIEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:JOSEFA
Other - Last Name:JUSTINIANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:2311 ENERGY DR BLDG 9
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-4343
Practice Address - Country:US
Practice Address - Phone:984-254-5635
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13739235Z00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist