Provider Demographics
NPI:1336108612
Name:GRAY, ANDREA B (MS)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:B
Last Name:GRAY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:MARIE
Other - Last Name:BILLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:823 PARK EAST BLVD STE H
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-0811
Mailing Address - Country:US
Mailing Address - Phone:765-448-6226
Mailing Address - Fax:
Practice Address - Street 1:823 PARK EAST BLVD STE H
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-0811
Practice Address - Country:US
Practice Address - Phone:765-448-6226
Practice Address - Fax:765-448-9416
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002183A231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000179545OtherANTHEM PROVIDER NUMBER
IN200180390Medicaid
INHA57500064Medicaid
IN9397785OtherPHCS PID NUMBER
IN815500H7Medicare PIN
IN9397785OtherPHCS PID NUMBER
IN640003406Medicare PIN
IN185820AMedicare PIN