Provider Demographics
NPI:1457050536
Name:GRAVER, J A (PEER SPECIALIST)
Entity Type:Individual
Prefix:
First Name:J
Middle Name:A
Last Name:GRAVER
Suffix:
Gender:F
Credentials:PEER SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 ANDOVER PARK W STE 107
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-3911
Mailing Address - Country:US
Mailing Address - Phone:360-819-3421
Mailing Address - Fax:
Practice Address - Street 1:1101 ANDOVER PARK W STE 107
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-3911
Practice Address - Country:US
Practice Address - Phone:360-819-3421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist