Provider Demographics
NPI:1508070384
Name:GRAICHEN, EDITH (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:EDITH
Middle Name:
Last Name:GRAICHEN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 ARBOR LN
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-1437
Mailing Address - Country:US
Mailing Address - Phone:617-543-0430
Mailing Address - Fax:
Practice Address - Street 1:30 ARBOR LN
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-1437
Practice Address - Country:US
Practice Address - Phone:617-543-0430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3911235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0303925Medicaid