Provider Demographics
NPI:1851784508
Name:GRAVEMAN, KARA
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:GRAVEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 WILLIAMS ST.
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:SD
Mailing Address - Zip Code:57785
Mailing Address - Country:US
Mailing Address - Phone:605-347-2991
Mailing Address - Fax:605-347-4944
Practice Address - Street 1:1807 WILLIAMS ST.
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:SD
Practice Address - Zip Code:57785
Practice Address - Country:US
Practice Address - Phone:605-347-2991
Practice Address - Fax:605-347-4944
Is Sole Proprietor?:No
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD12091543101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)