Provider Demographics
NPI:1073746418
Name:GRAFT, SHELLEY SUE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:SUE
Last Name:GRAFT
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MISS
Other - First Name:SHELLEY
Other - Middle Name:SUE
Other - Last Name:BUCHANAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:491 STRATTON DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-2964
Mailing Address - Country:US
Mailing Address - Phone:859-653-9124
Mailing Address - Fax:610-300-4612
Practice Address - Street 1:491 STRATTON DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-2964
Practice Address - Country:US
Practice Address - Phone:859-653-9124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY139334235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty