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General NPI Number Information
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NPI Number | 1699888545
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Entity Type | Individual
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Provider Name | RICHARD ALLEN GRAVES M.A. CCC-A
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Gender | Male
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | ILLIANA VAMC 1900 EAST MAIN ST
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City | DANVILLE
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State | IL
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Zip | 61832
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Country | US
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Telephone | 217-554-5622
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Fax |
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Provider Business Mailing Address
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Address Line | 2238 CHURCHILL DR
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City | SAINT JOSEPH
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State | IL
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Zip | 61873-9412
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 14700927
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License Number State | IL
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