Provider Demographics
NPI:1447393350
Name:GRAVETT, DOMENICA LOUISE (MA,CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:DOMENICA
Middle Name:LOUISE
Last Name:GRAVETT
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
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Mailing Address - Street 1:4208 E SHELLYNN DR
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-3634
Mailing Address - Country:US
Mailing Address - Phone:605-333-4538
Mailing Address - Fax:605-333-1963
Practice Address - Street 1:1305 W 18TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-0401
Practice Address - Country:US
Practice Address - Phone:605-333-4538
Practice Address - Fax:605-333-1963
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist