Provider Demographics
NPI:1619789039
Name:ELLIS-GRAHAM, JOLIA TROI
Entity type:Individual
Prefix:MISS
First Name:JOLIA
Middle Name:TROI
Last Name:ELLIS-GRAHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 FRONTAGE RD APT 1009
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-2222
Mailing Address - Country:US
Mailing Address - Phone:609-433-0086
Mailing Address - Fax:
Practice Address - Street 1:1920 FRONTAGE RD APT 1009
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2222
Practice Address - Country:US
Practice Address - Phone:609-433-0086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist