Provider Demographics
NPI:1174965198
Name:ROMICK, GRACE
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:ROMICK
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 1:3500 SW 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-1904
Mailing Address - Country:US
Mailing Address - Phone:785-272-4060
Mailing Address - Fax:785-272-7912
Practice Address - Street 1:3500 SW 10TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-1904
Practice Address - Country:US
Practice Address - Phone:785-272-4060
Practice Address - Fax:785-272-7912
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200748620AMedicaid