Provider Demographics
NPI:1427427772
Name:GRAVES, PATRICIA (SLP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:GRAVES
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:VERANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:1872 EAGLE GLEN DR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4025
Mailing Address - Country:US
Mailing Address - Phone:916-223-2099
Mailing Address - Fax:
Practice Address - Street 1:1872 EAGLE GLEN DR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4025
Practice Address - Country:US
Practice Address - Phone:916-223-2099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP7206235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASP7206OtherLICENSE