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NPI Code Detail

MEDICARE: MS. ELISABETH ANN GRAHAM M.S., CCC-SLP

MEDICARE: MS. ELISABETH ANN GRAHAM M.S., CCC-SLP
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
1235Z00000XSpeech-Language Pathologist2202003690VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093852386
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ELISABETH ANN GRAHAM M.S., CCC-SLP
Provider Business Mailing Address
First Line : 16846 CHESTNUT OVERLOOK DR
Second Line :
City : PURCELLVILLE
State : VA
Zip : 20132-2875
Country : US
Telephone Number : 703-864-5824
Fax Number : 703-864-5824
Provider Business Practice Location Address
First Line : 19465 DEERFIELD AVE STE 201
Second Line :
City : LANSDOWNE
State : VA
Zip : 20176-1703
Country : US
Telephone Number : 703-858-7620
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2007
Last Update Date : 06/05/2019

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