Provider Demographics
NPI:1225803778
Name:GRAW, TINA L (MA)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:L
Last Name:GRAW
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 DONOVAN DR
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-2641
Mailing Address - Country:US
Mailing Address - Phone:563-321-6647
Mailing Address - Fax:
Practice Address - Street 1:1225 E RIVER DR STE 330
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-5761
Practice Address - Country:US
Practice Address - Phone:563-424-0136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health