Basic Information
| Provider Information | |||||||||
| NPI: | 1861934242 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRAHAM | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | V | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.S., CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5231 BROOK WAY | ||||||||
| Address2: | #4 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210441617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4438808508 | ||||||||
| FaxNumber: | 3014980009 | ||||||||
| Practice Location | |||||||||
| Address1: | 14409 GREENVIEW DR | ||||||||
| Address2: | 102 | ||||||||
| City: | LAUREL | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207083293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014988100 | ||||||||
| FaxNumber: | 3014980009 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2016 | ||||||||
| LastUpdateDate: | 11/16/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 07487 | MD | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.