Individual
SUSAN GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Contact information
Practice address
1575 N 4TH ST, LARAMIE, WY 82072-2091
(307) 212-3284
(307) 212-3284
Mailing address
4026 GARDEN CT, CHEYENNE, WY 82001-2352
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
BACB1592243
WY
Other
Enumeration date
07/06/2026
Last updated
07/06/2026
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