Healthcare Provider Details

I. General information

NPI: 1699122259
Provider Name (Legal Business Name): JENNIFER LAUREN GRAVES (BLEES) M.S., CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2016
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 COMPASS RD
GLENVIEW IL
60026
US

IV. Provider business mailing address

724 BROOKHILL RANCH RD APT C
HOT SPRINGS AR
71909-9340
US

V. Phone/Fax

Practice location:
  • Phone: 877-787-3430
  • Fax: 847-441-0734
Mailing address:
  • Phone: 501-545-0110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: