Provider Demographics
NPI:1295177897
Name:GRAVES, ENSLEY SAKIRA (SLP)
Entity Type:Individual
Prefix:
First Name:ENSLEY
Middle Name:SAKIRA
Last Name:GRAVES
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 BECKHAM LN APT 404
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-3248
Mailing Address - Country:US
Mailing Address - Phone:803-387-1460
Mailing Address - Fax:
Practice Address - Street 1:714 BECKHAM LN APT 404
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3248
Practice Address - Country:US
Practice Address - Phone:803-387-1460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4676235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist