Provider Demographics
NPI:1356518484
Name:GRAU, KENNETH JOHN (MS CCC SLP)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:JOHN
Last Name:GRAU
Suffix:
Gender:M
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 MORICHES MIDDLE ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-1214
Mailing Address - Country:US
Mailing Address - Phone:516-380-4540
Mailing Address - Fax:
Practice Address - Street 1:45 CROSSWAYS EAST RD
Practice Address - Street 2:SAUL &ELAINNE SEIFF EDUCARE CENTER
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716
Practice Address - Country:US
Practice Address - Phone:631-218-4949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0159361235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist