Provider Demographics
NPI:1386958254
Name:GRAEBE, LESLIE (MS)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:
Last Name:GRAEBE
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:PO BOX 6122
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26506-6122
Mailing Address - Country:US
Mailing Address - Phone:304-293-6817
Mailing Address - Fax:304-293-2905
Practice Address - Street 1:805 ALLEN HALL
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506-6122
Practice Address - Country:US
Practice Address - Phone:304-293-6817
Practice Address - Fax:304-293-2905
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-0063235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist