Provider Demographics
NPI:1821257965
Name:GRAZIANI, MARIE D (AUD CCCA)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:D
Last Name:GRAZIANI
Suffix:
Gender:F
Credentials:AUD CCCA
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:ELIZABETH
Other - Last Name:DIVITA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:5170 US ROUTE 60 EAST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705
Mailing Address - Country:US
Mailing Address - Phone:304-528-4600
Mailing Address - Fax:304-523-4303
Practice Address - Street 1:5170 US ROUTE 60
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-2004
Practice Address - Country:US
Practice Address - Phone:304-528-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0486237600000X
WVA0202237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810013522Medicaid
KYP00644184Medicare PIN
WV4246341Medicare UPIN
WVP00644179Medicare PIN
KY0508906Medicare PIN