Provider Demographics
NPI:1619108552
Name:GRAHAM, VIRGINIA STROUD (SLP)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:STROUD
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:4235 E 109TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-7102
Mailing Address - Country:US
Mailing Address - Phone:918-640-4681
Mailing Address - Fax:
Practice Address - Street 1:4235 E 109TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-7102
Practice Address - Country:US
Practice Address - Phone:918-640-4681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3082235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist