Healthcare Provider Details

I. General information

NPI: 1396655775
Provider Name (Legal Business Name): BRIANNE GRAVES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 W WORLEY ST
COLUMBIA MO
65203-1038
US

IV. Provider business mailing address

5411 STEEPLECHASE DR
COLUMBIA MO
65203-2288
US

V. Phone/Fax

Practice location:
  • Phone: 573-214-3400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2018023245
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: