Provider Demographics
NPI:1184044372
Name:GRAHAM, MEGHAN (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
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 1:33 HOWLAND RD
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-3918
Mailing Address - Country:US
Mailing Address - Phone:585-704-6260
Mailing Address - Fax:
Practice Address - Street 1:7 CRANBERRY LN
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-1490
Practice Address - Country:US
Practice Address - Phone:585-704-6260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-26
Last Update Date:2014-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7111235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist