Provider Demographics
NPI:1861602203
Name:GRAHOVAC, PAUL G (MSSW, LCSW)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:G
Last Name:GRAHOVAC
Suffix:
Gender:M
Credentials:MSSW, LCSW
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 1062
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:WI
Mailing Address - Zip Code:54843-1062
Mailing Address - Country:US
Mailing Address - Phone:715-634-0222
Mailing Address - Fax:715-634-1722
Practice Address - Street 1:10045 N STATE ROAD 27
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:WI
Practice Address - Zip Code:54843-3525
Practice Address - Country:US
Practice Address - Phone:715-634-0222
Practice Address - Fax:715-634-1722
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1529-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39648200Medicaid