Provider Demographics
NPI:1033940747
Name:GUSTWILLER, GRACE ELAINE
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:ELAINE
Last Name:GUSTWILLER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 E ENON RD
Mailing Address - Street 2:
Mailing Address - City:YELLOW SPRINGS
Mailing Address - State:OH
Mailing Address - Zip Code:45387-1415
Mailing Address - Country:US
Mailing Address - Phone:419-966-6346
Mailing Address - Fax:
Practice Address - Street 1:4122 N LINDA DR
Practice Address - Street 2:
Practice Address - City:BELLBROOK
Practice Address - State:OH
Practice Address - Zip Code:45305-1320
Practice Address - Country:US
Practice Address - Phone:937-848-7831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-13
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3380418235Z00000X
OHCOND.20242782-SP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist