Provider Demographics
NPI:1669036968
Name:GRAVELLE, LUANN (CFPS)
Entity Type:Individual
Prefix:
First Name:LUANN
Middle Name:
Last Name:GRAVELLE
Suffix:
Gender:F
Credentials:CFPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:853 28TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:BACKUS
Mailing Address - State:MN
Mailing Address - Zip Code:56435-2328
Mailing Address - Country:US
Mailing Address - Phone:612-940-5505
Mailing Address - Fax:
Practice Address - Street 1:112 HIGHWAY 371 S
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:MN
Practice Address - Zip Code:56452-2638
Practice Address - Country:US
Practice Address - Phone:218-675-5101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist