Provider Demographics
NPI:1245453869
Name:GRAY, AMY JEAN (MSCCCSLP)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:JEAN
Last Name:GRAY
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1053 EASTERN PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-1559
Mailing Address - Country:US
Mailing Address - Phone:502-637-3545
Mailing Address - Fax:502-637-3545
Practice Address - Street 1:1053 EASTERN PKWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1559
Practice Address - Country:US
Practice Address - Phone:502-637-3545
Practice Address - Fax:502-637-3545
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-2676235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1607OtherPROVIDERID FOR FIRTSSTEPS