Provider Demographics
NPI:1649995085
Name:GLUECK, GRACE NEHARAH (LE)
Entity type:Individual
Prefix:MISS
First Name:GRACE
Middle Name:NEHARAH
Last Name:GLUECK
Suffix:
Gender:F
Credentials:LE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1337 S GRAND BLVD STE 111
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1136
Mailing Address - Country:US
Mailing Address - Phone:506-325-8484
Mailing Address - Fax:
Practice Address - Street 1:1337 S GRAND BLVD STE 111
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1136
Practice Address - Country:US
Practice Address - Phone:506-325-8484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL9730174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist