Provider Demographics
NPI:1740747575
Name:GRAHAM, KATHY ABBOTT (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:ABBOTT
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 1:299 TOMATO CT
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21050-3069
Mailing Address - Country:US
Mailing Address - Phone:410-322-1231
Mailing Address - Fax:
Practice Address - Street 1:299 TOMATO CT
Practice Address - Street 2:
Practice Address - City:FOREST HILL
Practice Address - State:MD
Practice Address - Zip Code:21050-3069
Practice Address - Country:US
Practice Address - Phone:410-322-1231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03097235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist