Provider Demographics
NPI:1790353621
Name:GRAVES, KAITLYNN DELANEY (MSW, LSW)
Entity type:Individual
Prefix:
First Name:KAITLYNN
Middle Name:DELANEY
Last Name:GRAVES
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 REDMOND WAY
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-1625
Mailing Address - Country:US
Mailing Address - Phone:614-906-9462
Mailing Address - Fax:
Practice Address - Street 1:501 MAIN ST
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-3622
Practice Address - Country:US
Practice Address - Phone:740-755-4730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2105797104100000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker