Healthcare Provider Details

I. General information

NPI: 1720532849
Provider Name (Legal Business Name): NICOLE GRAVES M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2016
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 BARRANCA PKWY
IRVINE CA
92604-4652
US

IV. Provider business mailing address

2005 KNOLLCREST
IRVINE CA
92603-1600
US

V. Phone/Fax

Practice location:
  • Phone: 949-255-3754
  • Fax:
Mailing address:
  • Phone: 949-936-5412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number17787
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: