Provider Demographics
NPI:1629451737
Name:GRACE, ALLISON A (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:A
Last Name:GRACE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1347 CULPEPPER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-7526
Mailing Address - Country:US
Mailing Address - Phone:314-578-3551
Mailing Address - Fax:855-744-8767
Practice Address - Street 1:36 KIRKHAM INDUSTRIAL DR STE 100
Practice Address - Street 2:
Practice Address - City:WEBSTER GROVES
Practice Address - State:MO
Practice Address - Zip Code:63119-1754
Practice Address - Country:US
Practice Address - Phone:314-578-3551
Practice Address - Fax:636-226-4682
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0188671041C0700X, 101YP2500X, 103TC1900X, 1041C0700X
MO0031131041C0700X, 101YP2500X, 103TC1900X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1629451737OtherNPI
MO1275052599OtherNPI