Provider Demographics
NPI:1164972220
Name:GRAY, COLLEEN (CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10376 LAKE MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-2681
Mailing Address - Country:US
Mailing Address - Phone:440-846-8804
Mailing Address - Fax:
Practice Address - Street 1:2300 DOVER CENTER RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-3102
Practice Address - Country:US
Practice Address - Phone:440-835-6322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-4443235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist