Provider Demographics
NPI:1629512082
Name:GRAY, COURTNEY (SLP-CCC)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3240 WASHINGTON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MC MURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-3180
Mailing Address - Country:US
Mailing Address - Phone:724-941-4434
Mailing Address - Fax:
Practice Address - Street 1:3240 WASHINGTON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-3180
Practice Address - Country:US
Practice Address - Phone:724-941-4434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL013004235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist