Provider Demographics
NPI:1376722082
Name:GRAVILLE, DONNA JENSEN (PHD, CCC-SLP)
Entity Type:Individual
Prefix:PROF
First Name:DONNA
Middle Name:JENSEN
Last Name:GRAVILLE
Suffix:
Gender:F
Credentials:PHD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:PV01
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:503-494-3228
Mailing Address - Fax:503-494-4631
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:PV01
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-494-3228
Practice Address - Fax:503-494-4631
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10934235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR10934OtherSTATE OF OREGON