Provider Demographics
NPI:1457151995
Name:GRASE SPEAK LIFE SPEECH THERAPY & ASSOCIATES LLC
Entity type:Organization
Organization Name:GRASE SPEAK LIFE SPEECH THERAPY & ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TYRONECIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRASE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-220-4094
Mailing Address - Street 1:2 PATRIOT CRES
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-2815
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5833 POPLAR HALL DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3815
Practice Address - Country:US
Practice Address - Phone:757-775-7479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty