Provider Demographics
NPI:1295392348
Name:BRAY, JENNIFER (MS, SLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BRAY
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 1:4112 S CUSTER CT
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-1285
Mailing Address - Country:US
Mailing Address - Phone:509-280-4594
Mailing Address - Fax:
Practice Address - Street 1:4112 S CUSTER CT
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-1285
Practice Address - Country:US
Practice Address - Phone:509-280-4594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program