Provider Demographics
NPI:1215761887
Name:STEPHENSON, GRACE
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:STEPHENSON
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 1:2320 HOWE ST # 1
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1924
Mailing Address - Country:US
Mailing Address - Phone:805-312-1289
Mailing Address - Fax:
Practice Address - Street 1:2130 CENTER ST STE 200
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-1386
Practice Address - Country:US
Practice Address - Phone:510-548-8283
Practice Address - Fax:510-548-2938
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program