Provider Demographics
NPI:1962068213
Name:BERTCH, GRACE A
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:A
Last Name:BERTCH
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 1:3355 MISSION AVE STE 123
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-1327
Mailing Address - Country:US
Mailing Address - Phone:760-529-4975
Mailing Address - Fax:760-529-4761
Practice Address - Street 1:3355 MISSION AVE STE 123
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-1327
Practice Address - Country:US
Practice Address - Phone:760-529-4975
Practice Address - Fax:760-529-4761
Is Sole Proprietor?:No
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist