Provider Demographics
NPI:1609171057
Name:GRAVES, KATHRYN (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:GRAVES
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3175 E GENESEE ST STE 5
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224-1613
Mailing Address - Country:US
Mailing Address - Phone:315-810-2423
Mailing Address - Fax:
Practice Address - Street 1:3175 E GENESEE ST STE 5
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13224-1613
Practice Address - Country:US
Practice Address - Phone:315-810-2423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-17
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019958235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist