Provider Demographics
NPI:1659661627
Name:GRAHAM, CARLY GENE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CARLY
Middle Name:GENE
Last Name:GRAHAM
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 1:3525 NW 56TH ST
Mailing Address - Street 2:SUITE A-150
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4550
Mailing Address - Country:US
Mailing Address - Phone:405-548-4300
Mailing Address - Fax:
Practice Address - Street 1:3525 NW 56TH ST
Practice Address - Street 2:SUITE A-150
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4550
Practice Address - Country:US
Practice Address - Phone:405-548-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3729235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist