Healthcare Provider Details

I. General information

NPI: 1538070123
Provider Name (Legal Business Name): CASEY RAE GRAHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NIC RAE GRAHAM

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 RESPONSE RD STE 200
SACRAMENTO CA
95815-5255
US

IV. Provider business mailing address

2276 SANDCASTLE WAY
SACRAMENTO CA
95833-3411
US

V. Phone/Fax

Practice location:
  • Phone: 916-974-2599
  • Fax:
Mailing address:
  • Phone: 916-626-7497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: