Provider Demographics
NPI:1477324564
Name:CRAVATTA, JOHANNA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:CRAVATTA
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28570 W THOME RD
Mailing Address - Street 2:
Mailing Address - City:ROCK FALLS
Mailing Address - State:IL
Mailing Address - Zip Code:61071-9234
Mailing Address - Country:US
Mailing Address - Phone:815-535-6889
Mailing Address - Fax:
Practice Address - Street 1:1900 W LE FEVRE RD
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:IL
Practice Address - Zip Code:61081-9202
Practice Address - Country:US
Practice Address - Phone:815-622-0858
Practice Address - Fax:815-622-3182
Is Sole Proprietor?:No
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.017468235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist