Provider Demographics
NPI:1043552375
Name:GRAY, TRAVIS ANDREW (BS)
Entity Type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:ANDREW
Last Name:GRAY
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:794 CHARTON RD
Mailing Address - Street 2:
Mailing Address - City:PLUMERVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72127-8882
Mailing Address - Country:US
Mailing Address - Phone:501-208-6581
Mailing Address - Fax:
Practice Address - Street 1:794 CHARTON RD
Practice Address - Street 2:
Practice Address - City:PLUMERVILLE
Practice Address - State:AR
Practice Address - Zip Code:72127-8882
Practice Address - Country:US
Practice Address - Phone:501-208-6581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant