Provider Demographics
NPI:1518039932
Name:GRAHAM, RONNIE KAREN
Entity Type:Individual
Prefix:MS
First Name:RONNIE
Middle Name:KAREN
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 FOREST HILL RD
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-1911
Mailing Address - Country:US
Mailing Address - Phone:919-933-7769
Mailing Address - Fax:919-560-2103
Practice Address - Street 1:231 FOREST HILL RD
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-1911
Practice Address - Country:US
Practice Address - Phone:919-933-7769
Practice Address - Fax:919-560-2103
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4094235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412142Medicaid