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NPI Code Detail

MEDICARE: CARRIE RAYE GRAVATT M.A., CCC-SLP

MEDICARE: CARRIE RAYE GRAVATT M.A., CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist0001411CO

General Provider Information

NPI Number : 1801359203
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARRIE RAYE GRAVATT M.A., CCC-SLP
Provider Business Mailing Address
First Line : 3 WINDFLOWER CT
Second Line :
City : PUEBLO
State : CO
Zip : 81001-1119
Country : US
Telephone Number : 719-250-1144
Fax Number :
Provider Business Practice Location Address
First Line : 3960 IVYWOOD LN
Second Line :
City : PUEBLO
State : CO
Zip : 81005-2567
Country : US
Telephone Number : 719-924-9850
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2019
Last Update Date : 04/11/2019

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Directions to “ CARRIE RAYE GRAVATT M.A., CCC-SLP” Practice Location

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