Healthcare Provider Details

I. General information

NPI: 1972414951
Provider Name (Legal Business Name): EDWARD LEE FOSTER GRAHAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 SNELLING AVE N
SAINT PAUL MN
55104-2878
US

IV. Provider business mailing address

7635 WOODLAWN DR
SAINT PAUL MN
55112-4059
US

V. Phone/Fax

Practice location:
  • Phone: 651-800-5494
  • Fax:
Mailing address:
  • Phone: 651-216-5285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number304410
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: