Provider Demographics
NPI:1891010237
Name:GRAVELLE, SARAH M (MS)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:M
Last Name:GRAVELLE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 OAK ST
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-3610
Mailing Address - Country:US
Mailing Address - Phone:218-829-7140
Mailing Address - Fax:218-829-7124
Practice Address - Street 1:209 S 2ND ST STE 415
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-3668
Practice Address - Country:US
Practice Address - Phone:507-344-1400
Practice Address - Fax:507-344-1098
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2150106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist