Provider Demographics
NPI:1508135120
Name:GRAY, JOANN (SLP)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 N SAM HOUSTON PKWY E
Mailing Address - Street 2:SUITE 246
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-3305
Mailing Address - Country:US
Mailing Address - Phone:713-510-5699
Mailing Address - Fax:832-932-1629
Practice Address - Street 1:340 N SAM HOUSTON PKWY E
Practice Address - Street 2:SUITE 246
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-3305
Practice Address - Country:US
Practice Address - Phone:713-510-5699
Practice Address - Fax:832-932-1629
Is Sole Proprietor?:No
Enumeration Date:2011-12-28
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102971235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist