Provider Demographics
NPI:1194774463
Name:GRAHAM, HENRY FRANKLIN JR (MA,CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:HENRY
Middle Name:FRANKLIN
Last Name:GRAHAM
Suffix:JR
Gender:M
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 JADE CIR
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29115-8166
Mailing Address - Country:US
Mailing Address - Phone:803-533-8092
Mailing Address - Fax:803-268-9603
Practice Address - Street 1:107 JADE CIR
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-8166
Practice Address - Country:US
Practice Address - Phone:803-533-8092
Practice Address - Fax:803-268-9603
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2674235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA0217Medicaid