Provider Demographics
NPI:1649675679
Name:BRODY, GRACE
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:BRODY
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 1:150 N MILLER RD
Mailing Address - Street 2:BLDG. 150A
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3770
Mailing Address - Country:US
Mailing Address - Phone:330-867-2240
Mailing Address - Fax:330-867-2245
Practice Address - Street 1:150 N MILLER RD
Practice Address - Street 2:BLDG. 150A
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3770
Practice Address - Country:US
Practice Address - Phone:330-867-2240
Practice Address - Fax:330-867-2245
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND 2015089235Z00000X
OHSP11870235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist