Provider Demographics
NPI:1114957982
Name:GRAHAM, VALERIE S (MS)
Entity Type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:S
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:VALERIE
Other - Middle Name:A
Other - Last Name:SHEPARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:110 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-2602
Mailing Address - Country:US
Mailing Address - Phone:304-622-4327
Mailing Address - Fax:304-622-2144
Practice Address - Street 1:110 N 6TH ST
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-2602
Practice Address - Country:US
Practice Address - Phone:304-622-4327
Practice Address - Fax:304-622-2144
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVA0032231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3402009000Medicaid
WVWV00381OtherHEALTH PLAN
WV3402009000Medicaid