MEDICARE: DR. SANDRA E GRAHAM PH.D.

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	103T00000X	Psychologist	1888	WI

General Provider Information

NPI Number	:	1093780710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA E GRAHAM PH.D.

Provider Business Mailing Address
First Line	:	10533 W NATIONAL AVE
Second Line	:	SUITE 300
City	:	MILWAUKEE
State	:	WI
Zip	:	53227-2041
Country	:	US
Telephone Number	:	414-327-5200
Fax Number	:	414-327-5400

Provider Business Practice Location Address
First Line	:	10533 W NATIONAL AVE
Second Line	:	SUITE 300
City	:	MILWAUKEE
State	:	WI
Zip	:	53227-2041
Country	:	US
Telephone Number	:	414-327-5200
Fax Number	:	414-327-5400

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

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	07/08/2007

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