Provider Demographics
NPI:1003609652
Name:FRAY, AVERY MARIE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:AVERY
Middle Name:MARIE
Last Name:FRAY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19142 BIG TIMBER RD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-8610
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3310 S BROADWAY AVE STE 100I
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-7818
Practice Address - Country:US
Practice Address - Phone:903-781-1832
Practice Address - Fax:877-798-4959
Is Sole Proprietor?:No
Enumeration Date:2025-05-27
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119526235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist