Provider Demographics
NPI:1730205956
Name:SIEVERS, GRACE MARIE (SLP)
Entity type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:MARIE
Last Name:SIEVERS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 MEDINAH RD
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-2570
Mailing Address - Country:US
Mailing Address - Phone:630-295-5244
Mailing Address - Fax:
Practice Address - Street 1:600 MEDINAH RD
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172-2570
Practice Address - Country:US
Practice Address - Phone:630-295-5244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146003671235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist