Provider Demographics
NPI:1598038705
Name:LE GRAY, CHRISTINA T (SLP)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:T
Last Name:LE GRAY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MS
Other - First Name:CHRISTINA
Other - Middle Name:T
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:PO BOX 110429
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80042-0429
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16120 NE 8TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98008-3937
Practice Address - Country:US
Practice Address - Phone:425-747-4004
Practice Address - Fax:425-747-1069
Is Sole Proprietor?:No
Enumeration Date:2012-02-17
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60254158235Z00000X
COSLP.0001002235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7018120Medicaid