Provider Demographics
NPI:1861905606
Name:GRAHAM, ELIZABETH ROCKWELL (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ROCKWELL
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 FOX HOLW
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76205-5141
Mailing Address - Country:US
Mailing Address - Phone:940-391-3788
Mailing Address - Fax:
Practice Address - Street 1:6399 FISHTRAP RD
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76208-1607
Practice Address - Country:US
Practice Address - Phone:214-608-7120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107124235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist