Provider Demographics
NPI:1578234423
Name:GRAVES, KAITLYN (BA, SLPA)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:GRAVES
Suffix:
Gender:F
Credentials:BA, SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3270 SE 58TH AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34480-1382
Mailing Address - Country:US
Mailing Address - Phone:352-390-0092
Mailing Address - Fax:
Practice Address - Street 1:3270 SE 58TH AVE STE 2
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34480-1382
Practice Address - Country:US
Practice Address - Phone:352-390-0092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI51732355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty