Provider Demographics
NPI:1982347019
Name:BRAY, LAURA WELLBORN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:WELLBORN
Last Name:BRAY
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 1:423 COUNTRY SIDE LN
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-5531
Mailing Address - Country:US
Mailing Address - Phone:214-235-3635
Mailing Address - Fax:
Practice Address - Street 1:1005 W JEFFERSON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-5090
Practice Address - Country:US
Practice Address - Phone:214-646-1570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-17
Last Update Date:2022-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19790235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist