Provider Demographics
NPI:1750814653
Name:GRAHAM, MEGAN R
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:R
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 1:1233 N MESA DR
Mailing Address - Street 2:1170
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-2754
Mailing Address - Country:US
Mailing Address - Phone:321-508-8662
Mailing Address - Fax:
Practice Address - Street 1:1233 N MESA DR
Practice Address - Street 2:1170
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-2754
Practice Address - Country:US
Practice Address - Phone:321-508-8662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA104952355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant