Provider Demographics
NPI:1003432352
Name:GRAVES, SHIRLEY ANN (CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:ANN
Last Name:GRAVES
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 STOKES RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-1523
Mailing Address - Country:US
Mailing Address - Phone:609-304-6141
Mailing Address - Fax:
Practice Address - Street 1:925 S BLACK HORSE PIKE STE B
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08094-1900
Practice Address - Country:US
Practice Address - Phone:856-562-5892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJYSO2365235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist