Provider Demographics
NPI:1003167750
Name:DEGRAW, JOLEIGH A
Entity Type:Individual
Prefix:
First Name:JOLEIGH
Middle Name:A
Last Name:DEGRAW
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:PO BOX 51354
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89435-1354
Mailing Address - Country:US
Mailing Address - Phone:866-832-3015
Mailing Address - Fax:
Practice Address - Street 1:4860 VISTA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-2863
Practice Address - Country:US
Practice Address - Phone:408-600-9317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst