Provider Demographics
NPI:1275345134
Name:GRAHAM, TERESA KAY (PHD)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:KAY
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4905 N INDIAN OAK ST
Mailing Address - Street 2:
Mailing Address - City:BEL AIRE
Mailing Address - State:KS
Mailing Address - Zip Code:67226-7664
Mailing Address - Country:US
Mailing Address - Phone:316-680-3582
Mailing Address - Fax:
Practice Address - Street 1:4905 N INDIAN OAK ST
Practice Address - Street 2:
Practice Address - City:BEL AIRE
Practice Address - State:KS
Practice Address - Zip Code:67226-7664
Practice Address - Country:US
Practice Address - Phone:316-680-3582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS562235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS562OtherKANSAS DEPARTMENT OF HEALTH OCCUPATIONS CREDENTIALING NUMBER