Provider Demographics
NPI:1194940940
Name:GRAHAM, RACHEL MARA (MS, CAGS)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:MARA
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MS, CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2604 DEMPSTER ST
Mailing Address - Street 2:SUITE 510
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-8412
Mailing Address - Country:US
Mailing Address - Phone:847-824-1235
Mailing Address - Fax:847-824-2386
Practice Address - Street 1:2604 DEMPSTER ST
Practice Address - Street 2:SUITE 510
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-8412
Practice Address - Country:US
Practice Address - Phone:847-824-1235
Practice Address - Fax:847-824-2386
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool