Provider Demographics
NPI:1326027608
Name:GRAHAM, CARA ELAINE (AUD)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:ELAINE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 CHESTER DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1001
Mailing Address - Country:US
Mailing Address - Phone:765-962-2242
Mailing Address - Fax:
Practice Address - Street 1:775 WAUKEGAN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-4342
Practice Address - Country:US
Practice Address - Phone:800-317-0711
Practice Address - Fax:800-434-7113
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002322A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000288066OtherANTHEM
OH000000543991OtherANTHEM
OH000000520172OtherANTHEM BCBS
IN200437550Medicaid
OH2705344Medicaid
IN200437550Medicaid
OH000000543991OtherANTHEM
OHP00461451Medicare PIN
INP00015595Medicare PIN
OHGR4205242Medicare PIN