Provider Demographics
NPI:1538823604
Name:GRAY, FAITH JUNE-MARIE (MA, CF-SLP)
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:JUNE-MARIE
Last Name:GRAY
Suffix:
Gender:F
Credentials:MA, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 TIMBERCREEK DR
Mailing Address - Street 2:
Mailing Address - City:GRAND LEDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48837-2327
Mailing Address - Country:US
Mailing Address - Phone:517-898-7930
Mailing Address - Fax:
Practice Address - Street 1:12800 ESCANABA DR
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:MI
Practice Address - Zip Code:48820-8680
Practice Address - Country:US
Practice Address - Phone:517-669-7228
Practice Address - Fax:517-669-5675
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI715200080235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1184817728Medicaid