Provider Demographics
NPI:1720676653
Name:CLAY, GRACE CHELSEA
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:CHELSEA
Last Name:CLAY
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 1:4105 VINESHIRE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-4623
Mailing Address - Country:US
Mailing Address - Phone:216-466-1821
Mailing Address - Fax:
Practice Address - Street 1:301 OBETZ RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-4036
Practice Address - Country:US
Practice Address - Phone:614-409-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty