Provider Demographics
NPI:1972978484
Name:GRAVES, LAURA B I (MS CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:B
Last Name:GRAVES
Suffix:I
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:MRS
Other - First Name:LAURA
Other - Middle Name:B
Other - Last Name:WALLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC/SLP
Mailing Address - Street 1:6701 W 121ST ST
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66209-2003
Mailing Address - Country:US
Mailing Address - Phone:913-206-7505
Mailing Address - Fax:913-206-7505
Practice Address - Street 1:6701 W 121ST ST
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66209-2003
Practice Address - Country:US
Practice Address - Phone:913-206-7505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-09
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2079235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist