MEDICARE: CAITLYN GRAHAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	2202007297	VA

General Provider Information

NPI Number	:	1023544400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAITLYN GRAHAM

Provider Business Mailing Address
First Line	:	215 LAKE CLUB CT
Second Line	:	#103
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22902-7281
Country	:	US
Telephone Number	:	910-547-5694
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 LAKE CLUB CT
Second Line	:	#103
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22902-7281
Country	:	US
Telephone Number	:	910-547-5694
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2017
Last Update Date	:	05/04/2017

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Directions to “ CAITLYN GRAHAM ” Practice Location

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