Provider Demographics
NPI:1063796399
Name:GRAY, SARA ELIZABETH (AUD)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:ELIZABETH
Last Name:GRAY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 W 5TH ST STE 410
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-5067
Mailing Address - Country:US
Mailing Address - Phone:432-333-8870
Mailing Address - Fax:432-333-8136
Practice Address - Street 1:540 W 5TH ST STE 410
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5067
Practice Address - Country:US
Practice Address - Phone:432-333-8870
Practice Address - Fax:432-333-8136
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80304231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX345514901Medicaid