Provider Demographics
NPI:1588789390
Name:GRAHAM, CHERYL LM (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:LM
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 W SUPERIOR ST
Mailing Address - Street 2:702
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-1805
Mailing Address - Country:US
Mailing Address - Phone:218-722-4058
Mailing Address - Fax:218-722-4059
Practice Address - Street 1:314 W SUPERIOR ST
Practice Address - Street 2:702
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1805
Practice Address - Country:US
Practice Address - Phone:218-722-4058
Practice Address - Fax:218-722-4059
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN75601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6254820OtherMEDICA
MN074235OtherVALUE OPTIONS
MN1001289OtherBHP-MNCARE
MN385RHAOtherBLUE CROSS
MN110221OtherBHP-UCARE