Provider Demographics
NPI:1306682828
Name:TEGG, GRACE KATHRYN (LMSW)
Entity type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:KATHRYN
Last Name:TEGG
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:GRACE
Other - Middle Name:KATHRYN
Other - Last Name:TEGG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:101 S ALLUMBAUGH WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-5658
Mailing Address - Country:US
Mailing Address - Phone:616-745-3710
Mailing Address - Fax:
Practice Address - Street 1:101 S ALLUMBAUGH WAY
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-5658
Practice Address - Country:US
Practice Address - Phone:616-745-3710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW42457104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker