Healthcare Provider Details

I. General information

NPI: 1396665725
Provider Name (Legal Business Name): ALLISON BLAIR GRAHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 MARLTON PIKE E STE J51
CHERRY HILL NJ
08003-4106
US

IV. Provider business mailing address

118 KEATS PL
CHERRY HILL NJ
08003-3545
US

V. Phone/Fax

Practice location:
  • Phone: 856-200-8392
  • Fax:
Mailing address:
  • Phone: 856-745-8547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberTL-5131
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: