Doctor Name: | MRS. GRACE RAISSA GUSTAFSON |
NPI Number: | 1972656122 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS CCC SLP |
License Number: | 5053 |
Business Practice Address: | Prenet Family Health Services 237 Millbury St Worcester, MA - 01610 |
Business Phone Number: | 5087551228 |
Business Fax Number: | |
Mailing Address: | 359 West Thompson Rd, THOMPSON |
State: | CT |
Postal Code: | 06277 |
Phone Number: | 8609630267 |
Fax Number: | |
NPI Enumeration Date: | 01/19/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 5053 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MA |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |