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General NPI Number Information
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NPI Number | 1972414951
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Entity Type | Individual
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Provider Name | EDWARD LEE FOSTER GRAHAM
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Gender | Male
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Dates
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Enumeration Date | 09/16/2026
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Last Update Date | 09/16/2026
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Provider Practice Location Address
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Address Line | 625 SNELLING AVE N
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City | SAINT PAUL
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State | MN
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Zip | 55104-2878
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Country | US
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Telephone | 651-800-5494
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Fax |
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Provider Business Mailing Address
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Address Line | 7635 WOODLAWN DR
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City | SAINT PAUL
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State | MN
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Zip | 55112-4059
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Country | US
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Telephone | 651-216-5285
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Fax |
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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 | 225C00000X
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Taxonomy Name | Rehabilitation Counselor
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License Number | 304410
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License Number State | MN
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