Provider Demographics
NPI:1144112822
Name:GRAHAM, DAVID RICHARD (HIS/HID)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:RICHARD
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:HIS/HID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9006 CARTER PATH
Mailing Address - Street 2:
Mailing Address - City:INVER GROVE HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55076-3540
Mailing Address - Country:US
Mailing Address - Phone:952-953-4936
Mailing Address - Fax:
Practice Address - Street 1:131 CARMICHAEL RD STE 204
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-8271
Practice Address - Country:US
Practice Address - Phone:715-318-2310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2976237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist