Provider Demographics
NPI:1639399652
Name:GRAY, IEISHA M (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:IEISHA
Middle Name:M
Last Name:GRAY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 GRAND AVE APT 3E
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-2053
Mailing Address - Country:US
Mailing Address - Phone:201-348-5010
Mailing Address - Fax:201-330-1017
Practice Address - Street 1:1911 GRAND AVE APT 3E
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-2053
Practice Address - Country:US
Practice Address - Phone:201-348-5010
Practice Address - Fax:201-330-1017
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00492200235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist