Healthcare Provider Details

I. General information

NPI: 1477122679
Provider Name (Legal Business Name): GRAHAM MCCOLL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2021
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4380 AUBURN BLVD
SACRAMENTO CA
95841-4107
US

IV. Provider business mailing address

4380 AUBURN BLVD
SACRAMENTO CA
95841-4107
US

V. Phone/Fax

Practice location:
  • Phone: 916-771-8255
  • Fax:
Mailing address:
  • Phone: 916-771-8255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number21807
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: