Provider Demographics
NPI:1801492434
Name:ELISABETH GRAHAM
Entity type:Organization
Organization Name:ELISABETH GRAHAM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELISABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:703-864-5824
Mailing Address - Street 1:16846 CHESTNUT OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20132-2875
Mailing Address - Country:US
Mailing Address - Phone:703-828-7883
Mailing Address - Fax:540-338-5234
Practice Address - Street 1:16846 CHESTNUT OVERLOOK DR
Practice Address - Street 2:
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-2875
Practice Address - Country:US
Practice Address - Phone:703-828-7883
Practice Address - Fax:540-338-5234
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELISABETH GRAHAM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-09
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty