Provider Demographics
NPI:1366799660
Name:GRACE, CONSTANCE RUTH (CTR)
Entity type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:RUTH
Last Name:GRACE
Suffix:
Gender:F
Credentials:CTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16921 135TH PL SE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-6901
Mailing Address - Country:US
Mailing Address - Phone:425-221-5918
Mailing Address - Fax:425-235-7420
Practice Address - Street 1:16921 135TH PL SE
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98058-6901
Practice Address - Country:US
Practice Address - Phone:425-221-5918
Practice Address - Fax:425-235-7420
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor