Provider Demographics
NPI:1760892590
Name:GRAY, LORI (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:SHY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:26225 MILBURN DR
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44146-5935
Mailing Address - Country:US
Mailing Address - Phone:330-998-0573
Mailing Address - Fax:
Practice Address - Street 1:23401 EMERY RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-5142
Practice Address - Country:US
Practice Address - Phone:216-295-7792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-01
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3772235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist