=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023990678
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHRYN GRACE GRAPATIN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2025
-----------------------------------------------------
Last Update Date | 07/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3129 MICHIGAN AVE
-----------------------------------------------------
City | SHEBOYGAN
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53081-3062
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-458-1155
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | N123W5710 SHEBOYGAN RD UNIT 200
-----------------------------------------------------
City | CEDARBURG
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53012-3120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-323-2339
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 7062154
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------