Provider Demographics
NPI:1730718024
Name:LEYNES, GRACE M (HIS)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:M
Last Name:LEYNES
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 N LOGAN AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-4362
Mailing Address - Country:US
Mailing Address - Phone:217-442-1900
Mailing Address - Fax:217-442-1765
Practice Address - Street 1:107 S STATE ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IL
Practice Address - Zip Code:61856-1968
Practice Address - Country:US
Practice Address - Phone:217-762-2155
Practice Address - Fax:217-762-9062
Is Sole Proprietor?:No
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3228237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist