Individual
AMANDA R GRAVES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10021 DUPONT CIRCLE CT, FORT WAYNE, IN 46825-1604
(260) 426-8117
(260) 420-0817
Mailing address
10021 DUPONT CIRCLE CT, FORT WAYNE, IN 46825-1604
(260) 426-8117
(260) 420-0817
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
22003985A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200543810
—
IN
Enumeration date
10/03/2008
Last updated
06/20/2016
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