Healthcare Provider Details

I. General information

NPI: 1972847341
Provider Name (Legal Business Name): HEATHER LYNN GRAHAM M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2012
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48075 POW WOW HWY
PONSFORD MN
56575
US

IV. Provider business mailing address

PO BOX 163
AKELEY MN
56433-0163
US

V. Phone/Fax

Practice location:
  • Phone: 218-573-4100
  • Fax:
Mailing address:
  • Phone: 701-630-0824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number388918
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: