Provider Demographics
NPI:1063729036
Name:GRAHAM, STEPHANIE RICKE (MA CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:RICKE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:ANNE
Other - Last Name:RICKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC/SLP
Mailing Address - Street 1:1215 FARRISH DRIVE
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401
Mailing Address - Country:US
Mailing Address - Phone:815-508-1909
Mailing Address - Fax:
Practice Address - Street 1:FREDERICKSBURG ACADAMY 10800 ACADAMY DRIVE
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408
Practice Address - Country:US
Practice Address - Phone:540-898-0020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-11
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202006945235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist