Provider Demographics
NPI:1093310849
Name:GRAY, REBECCA (MSED CCC-SLP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:MSED CCC-SLP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:ZALESKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED CCC-SLP
Mailing Address - Street 1:367 JONES HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12138-4901
Mailing Address - Country:US
Mailing Address - Phone:203-610-1214
Mailing Address - Fax:
Practice Address - Street 1:160 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-1893
Practice Address - Country:US
Practice Address - Phone:518-437-6590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
14360285235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist