Provider Demographics
NPI:1932429032
Name:GRACIA, MARLA FAYE (AUD)
Entity type:Individual
Prefix:
First Name:MARLA
Middle Name:FAYE
Last Name:GRACIA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8129 COLBI LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76120-5636
Mailing Address - Country:US
Mailing Address - Phone:440-915-6204
Mailing Address - Fax:817-451-4828
Practice Address - Street 1:1261 W GREEN OAKS BLVD STE 105
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-8349
Practice Address - Country:US
Practice Address - Phone:817-451-4818
Practice Address - Fax:817-451-4828
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
231H00000X
TX80225231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1D5546OtherMEDICARE
TX411489401Medicaid