=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558009308
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NATALIE MCGRAW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2022
-----------------------------------------------------
Last Update Date | 05/23/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1522 ELLIS ST
-----------------------------------------------------
City | PASS CHRISTIAN
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39571-4912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-715-7073
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 HORIZON DR STE 310
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27615-4926
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-424-5080
-----------------------------------------------------
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 | 110877
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------