Provider Demographics
NPI:1184880288
Name:GRAY, KENZIE RIGMAIDEN (MED, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KENZIE
Middle Name:RIGMAIDEN
Last Name:GRAY
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13231 ALCOTT FOREST LN
Mailing Address - Street 2:
Mailing Address - City:ROSHARON
Mailing Address - State:TX
Mailing Address - Zip Code:77583-0350
Mailing Address - Country:US
Mailing Address - Phone:832-512-0672
Mailing Address - Fax:
Practice Address - Street 1:13231 ALCOTT FOREST LN
Practice Address - Street 2:
Practice Address - City:ROSHARON
Practice Address - State:TX
Practice Address - Zip Code:77583-0350
Practice Address - Country:US
Practice Address - Phone:832-512-0672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103581235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist