Provider Demographics
NPI:1326588955
Name:GRAHAM, ANGELICA MARIA MANZO (MS)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:MARIA MANZO
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 N SUNRISE AVE
Mailing Address - Street 2:AVE STE 1105
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2924
Mailing Address - Country:US
Mailing Address - Phone:916-771-8255
Mailing Address - Fax:916-771-8211
Practice Address - Street 1:151 N SUNRISE AVE
Practice Address - Street 2:SUITE 1105
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2924
Practice Address - Country:US
Practice Address - Phone:916-771-8255
Practice Address - Fax:916-771-8211
Is Sole Proprietor?:No
Enumeration Date:2017-03-01
Last Update Date:2018-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26644235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist