Provider Demographics
NPI:1952771487
Name:GRAHAM, ASHLEY (MS ED)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2733 WEHRLE DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7348
Mailing Address - Country:US
Mailing Address - Phone:716-631-7503
Mailing Address - Fax:716-631-7695
Practice Address - Street 1:2733 WEHRLE DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7348
Practice Address - Country:US
Practice Address - Phone:716-631-7503
Practice Address - Fax:716-631-7695
Is Sole Proprietor?:No
Enumeration Date:2015-09-27
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY025218235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program