Provider Demographics
NPI:1932429032
Name:GRACIA, MARLA FAYE (AUD)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:FAYE
Last Name:GRACIA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12001 SOUTH FWY STE 209
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-7214
Mailing Address - Country:US
Mailing Address - Phone:682-385-7010
Mailing Address - Fax:682-382-7011
Practice Address - Street 1:3132 MATLOCK ROAD
Practice Address - Street 2:STE 303
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-7601
Practice Address - Country:US
Practice Address - Phone:817-472-7720
Practice Address - Fax:817-417-7280
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80225231H00000X
231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1D5546OtherMEDICARE
TX411489401Medicaid