Provider Demographics
NPI:1598046468
Name:GRAY, HAYLEE ANN (LMP)
Entity Type:Individual
Prefix:MRS
First Name:HAYLEE
Middle Name:ANN
Last Name:GRAY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5219 W CLEARWATER AVE
Mailing Address - Street 2:#9
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-1914
Mailing Address - Country:US
Mailing Address - Phone:509-736-6605
Mailing Address - Fax:509-736-6607
Practice Address - Street 1:5219 W CLEARWATER AVE
Practice Address - Street 2:#9
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-1914
Practice Address - Country:US
Practice Address - Phone:509-736-6605
Practice Address - Fax:509-736-6607
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60167905225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist