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NPI Code Detail

MEDICARE: DR. STEPHANIE RENE GRAHAM PHD

MEDICARE: DR. STEPHANIE RENE GRAHAM PHD
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
1103TC1900XCounseling Psychologist2888-057WI

General Provider Information

NPI Number : 1508167594
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STEPHANIE RENE GRAHAM PHD
Provider Business Mailing Address
First Line : 702 N BLACKHAWK AVE
Second Line : SUITE 209
City : MADISON
State : WI
Zip : 53705-3357
Country : US
Telephone Number : 608-509-8060
Fax Number :
Provider Business Practice Location Address
First Line : 5401 QUARRY PARK RD
Second Line :
City : MADISON
State : WI
Zip : 53718-7901
Country : US
Telephone Number : 844-767-3769
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2010
Last Update Date : 08/26/2025

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