Provider Demographics
NPI:1417261538
Name:GRAFF, GINA (SLP)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:GRAFF
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 1:1000 N LASALLE ST
Mailing Address - Street 2:APT 518
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-2676
Mailing Address - Country:US
Mailing Address - Phone:708-743-2594
Mailing Address - Fax:
Practice Address - Street 1:1000 N LASALLE ST
Practice Address - Street 2:APT 518
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-2676
Practice Address - Country:US
Practice Address - Phone:708-743-2594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-30
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146010073225400000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner