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General NPI Number Information
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NPI Number | 1487982658
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Entity Type | Individual
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Provider Name | JESSIE GRAHAM M.S., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 11/30/2009
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Last Update Date | 11/30/2009
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Provider Practice Location Address
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Address Line | 1109 BROOK RD
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City | WAITSFIELD
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State | VT
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Zip | 05673-7153
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Country | US
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Telephone | 802-496-4668
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Fax | 802-496-7824
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Provider Business Mailing Address
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Address Line | PO BOX 768
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City | WAITSFIELD
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State | VT
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Zip | 05673-0768
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Country | US
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Telephone | 802-496-4668
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Fax | 802-496-7824
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State | VT
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