Provider Demographics
NPI:1750073300
Name:GRAHAM, SUSAN MCDONALD (MA, CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MCDONALD
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17428 BECKFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-9304
Mailing Address - Country:US
Mailing Address - Phone:225-610-0206
Mailing Address - Fax:
Practice Address - Street 1:1020 MARLBROOK DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-5313
Practice Address - Country:US
Practice Address - Phone:225-272-3090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3851235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist