Provider Demographics
NPI:1760605505
Name:GRAVES, ERIN JENELLE (MASTERS DEGREE)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:JENELLE
Last Name:GRAVES
Suffix:
Gender:F
Credentials:MASTERS DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1841 WEST COUNTY ROAD 500 NORTH
Mailing Address - Street 2:
Mailing Address - City:BRAZIL
Mailing Address - State:IN
Mailing Address - Zip Code:47834
Mailing Address - Country:US
Mailing Address - Phone:812-239-8781
Mailing Address - Fax:812-448-9825
Practice Address - Street 1:1841 WEST COUNTY ROAD 500 NORTH
Practice Address - Street 2:
Practice Address - City:BRAZIL
Practice Address - State:IN
Practice Address - Zip Code:47834
Practice Address - Country:US
Practice Address - Phone:812-239-8781
Practice Address - Fax:812-448-9825
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004304A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist