Provider Demographics
NPI:1225333008
Name:GRAHAM, RUTH ANN (RUTH GRAHAM LAC)
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:ANN
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:RUTH GRAHAM LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2516 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-1913
Mailing Address - Country:US
Mailing Address - Phone:303-797-6656
Mailing Address - Fax:303-797-6616
Practice Address - Street 1:2516 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-1913
Practice Address - Country:US
Practice Address - Phone:303-797-6656
Practice Address - Fax:303-797-6616
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO471171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist