Healthcare Provider Details

I. General information

NPI: 1710141296
Provider Name (Legal Business Name): ERICA GRAHAM SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 STUBBS AVE STE D
MONROE LA
71201-5581
US

IV. Provider business mailing address

112 FAIR AVE
WINNSBORO LA
71295-2116
US

V. Phone/Fax

Practice location:
  • Phone: 318-388-8414
  • Fax: 318-388-8558
Mailing address:
  • Phone: 318-460-0260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number5920
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: