Provider Demographics
NPI:1265019772
Name:GRAY, DELAYNE MOULTON (MS, SLP)
Entity Type:Individual
Prefix:
First Name:DELAYNE
Middle Name:MOULTON
Last Name:GRAY
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 SCHILLING ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-7520
Mailing Address - Country:US
Mailing Address - Phone:406-240-8091
Mailing Address - Fax:
Practice Address - Street 1:3031 S RUSSELL ST STE B
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-8523
Practice Address - Country:US
Practice Address - Phone:406-396-4130
Practice Address - Fax:406-797-5008
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSLP-SP-LIC-9647235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist