Provider Demographics
NPI:1770919664
Name:HARDY, GRACE (ITDS)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:HARDY
Suffix:
Gender:F
Credentials:ITDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 18TH AVE N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-3756
Mailing Address - Country:US
Mailing Address - Phone:904-861-4927
Mailing Address - Fax:
Practice Address - Street 1:1210 18TH AVE N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3756
Practice Address - Country:US
Practice Address - Phone:904-861-4927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-24
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst