MEDICARE: SARAH ANN GRAVROK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	525-140	WI

General Provider Information

NPI Number	:	1679223556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH ANN GRAVROK

Provider Business Mailing Address
First Line	:	4469 1ST ST
Second Line	:
City	:	WINDSOR
State	:	WI
Zip	:	53598-9410
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4005 FELLAND RD STE 101&102
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53718-6461
Country	:	US
Telephone Number	:	608-412-3237
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2022
Last Update Date	:	01/02/2025

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Directions to “ SARAH ANN GRAVROK ” Practice Location

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