Provider Demographics
NPI:1396999751
Name:GRAHAM, ISABELLA LEITH (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ISABELLA
Middle Name:LEITH
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MS
Other - First Name:ISABELLA
Other - Middle Name:LEITH
Other - Last Name:WARLICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:2 DAVIS POINT LN UNIT 1A
Mailing Address - Street 2:
Mailing Address - City:CAPE ELIZABETH
Mailing Address - State:ME
Mailing Address - Zip Code:04107-2628
Mailing Address - Country:US
Mailing Address - Phone:207-767-9773
Mailing Address - Fax:207-541-9212
Practice Address - Street 1:2 DAVIS POINT LN UNIT 1A
Practice Address - Street 2:
Practice Address - City:CAPE ELIZABETH
Practice Address - State:ME
Practice Address - Zip Code:04107
Practice Address - Country:US
Practice Address - Phone:207-767-9773
Practice Address - Fax:207-541-9212
Is Sole Proprietor?:No
Enumeration Date:2008-11-12
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6193235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist