Provider Demographics
NPI:1093716466
Name:GRAHAM, PATRICIA ANNA (PSYD, HSPP)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:ANNA
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:PSYD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3831 KIRK ST
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-3419
Mailing Address - Country:US
Mailing Address - Phone:773-501-3557
Mailing Address - Fax:773-501-3557
Practice Address - Street 1:1112 US HIGHWAY 41 STE 108
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-1361
Practice Address - Country:US
Practice Address - Phone:773-501-3557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007159103TC0700X
IN20042049A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200818220Medicaid
IN060132-000OtherMAGELLAN
IA000000363699OtherANTHEM BLUE CROSS
INM400018206Medicare PIN
IA000000363699OtherANTHEM BLUE CROSS