Provider Demographics
NPI:1043908577
Name:VEZINA, GRACE FRANCES (MS)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:FRANCES
Last Name:VEZINA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 STALLSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-4934
Mailing Address - Country:US
Mailing Address - Phone:843-832-1795
Mailing Address - Fax:843-832-9499
Practice Address - Street 1:221 STALLSVILLE RD
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-4934
Practice Address - Country:US
Practice Address - Phone:843-832-1795
Practice Address - Fax:843-832-9499
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7998235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist