Provider Demographics
NPI:1881027464
Name:GRAHAM, COURTNEY MICHELLE
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:MICHELLE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:MICHELLE
Other - Last Name:SAXE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 BAILEY LN
Mailing Address - Street 2:REHAB DEPARTMENT
Mailing Address - City:BENTON
Mailing Address - State:IL
Mailing Address - Zip Code:62812-1969
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 BAILEY LN
Practice Address - Street 2:REHAB DEPARTMENT
Practice Address - City:BENTON
Practice Address - State:IL
Practice Address - Zip Code:62812-1969
Practice Address - Country:US
Practice Address - Phone:618-240-0139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.002810235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist