MEDICARE: MRS. ERIN JENELLE GRAVES MASTERS DEGREE

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	235Z00000X	Speech-Language Pathologist	22004304A	IN

General Provider Information

NPI Number	:	1760605505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ERIN JENELLE GRAVES MASTERS DEGREE

Provider Business Mailing Address
First Line	:	1841 WEST COUNTY ROAD 500 NORTH
Second Line	:
City	:	BRAZIL
State	:	IN
Zip	:	47834
Country	:	US
Telephone Number	:	812-239-8781
Fax Number	:	812-448-9825

Provider Business Practice Location Address
First Line	:	1841 WEST COUNTY ROAD 500 NORTH
Second Line	:
City	:	BRAZIL
State	:	IN
Zip	:	47834
Country	:	US
Telephone Number	:	812-239-8781
Fax Number	:	812-448-9825

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

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	07/09/2007

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