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General NPI Number Information
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NPI Number | 1568846707
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Entity Type | Organization
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Legal Business Name | GRAVEN AND ASSOCIATES, PLLC
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Dates
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Enumeration Date | 07/17/2015
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Last Update Date | 08/20/2024
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Provider Practice Location Address
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Address Line | 8007 LYNDON CENTRE WAY, SUITE # 101
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City | LOUISVILLE
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State | KY
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Zip | 40222
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Country | US
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Telephone | 502-690-8024
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2257
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City | CHESTERTON
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State | IN
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Zip | 46304-0357
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Country | US
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Telephone | 219-926-8320
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JACQUELYN GRAVEN
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Credential | PSYD
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Telephone | 219-926-8320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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