Provider Demographics
NPI:1437349115
Name:GRAVES, TRACEY ANN (PHD, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:ANN
Last Name:GRAVES
Suffix:
Gender:F
Credentials:PHD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8422 E SHEA BLVD
Mailing Address - Street 2:#103
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6661
Mailing Address - Country:US
Mailing Address - Phone:480-607-3801
Mailing Address - Fax:480-636-1922
Practice Address - Street 1:8422 E SHEA BLVD
Practice Address - Street 2:#103
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6661
Practice Address - Country:US
Practice Address - Phone:480-607-3801
Practice Address - Fax:480-636-1922
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP205235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist