Provider Demographics
NPI:1053000893
Name:WEATHERL, GRACE
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:WEATHERL
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 1:6814 ISLAND CIR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-1413
Mailing Address - Country:US
Mailing Address - Phone:432-230-3011
Mailing Address - Fax:
Practice Address - Street 1:160 GOULD ST STE 300
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-2300
Practice Address - Country:US
Practice Address - Phone:781-559-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker