Provider Demographics
NPI:1285709337
Name:HARGRAVE, JEAN M (MSCCC SLP)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:M
Last Name:HARGRAVE
Suffix:
Gender:F
Credentials:MSCCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WINTER CREEK CT
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45322-2247
Mailing Address - Country:US
Mailing Address - Phone:937-836-7223
Mailing Address - Fax:
Practice Address - Street 1:200 WINTER CREEK CT
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45322-2247
Practice Address - Country:US
Practice Address - Phone:937-836-7223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP 4312235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist