Provider Demographics
NPI:1033917539
Name:GRAHAM, MERCEDES D
Entity type:Individual
Prefix:
First Name:MERCEDES
Middle Name:D
Last Name:GRAHAM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 10TH AVE S STE 100
Mailing Address - Street 2:
Mailing Address - City:WAITE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:56387-1968
Mailing Address - Country:US
Mailing Address - Phone:763-688-4689
Mailing Address - Fax:
Practice Address - Street 1:314 10TH AVE S STE 100
Practice Address - Street 2:
Practice Address - City:WAITE PARK
Practice Address - State:MN
Practice Address - Zip Code:56387-1968
Practice Address - Country:US
Practice Address - Phone:763-688-4689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician