Provider Demographics
NPI:1386976223
Name:GRAVES, TREVA LYNN (MA CCC/SLP)
Entity type:Individual
Prefix:
First Name:TREVA
Middle Name:LYNN
Last Name:GRAVES
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1522 W 14TH ST
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-2864
Mailing Address - Country:US
Mailing Address - Phone:712-580-5009
Mailing Address - Fax:
Practice Address - Street 1:700 N.W. 7TH STREET
Practice Address - Street 2:POCAHONTAS MANOR
Practice Address - City:POCAHONTAS
Practice Address - State:IA
Practice Address - Zip Code:50574
Practice Address - Country:US
Practice Address - Phone:712-262-4704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01578235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist