Provider Demographics
NPI:1902113327
Name:GRAY, MARYANN (BA)
Entity Type:Individual
Prefix:MS
First Name:MARYANN
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1108
Mailing Address - Street 2:ACP 0016-07
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97308-1108
Mailing Address - Country:US
Mailing Address - Phone:541-447-5877
Mailing Address - Fax:
Practice Address - Street 1:850 W ANTLER AVE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-2129
Practice Address - Country:US
Practice Address - Phone:541-316-2041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education