Provider Demographics
NPI:1154710804
Name:GRAY, MARSHA (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:
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 1:1015 2ND ST
Mailing Address - Street 2:UNIT 109
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-3641
Mailing Address - Country:US
Mailing Address - Phone:256-659-8473
Mailing Address - Fax:
Practice Address - Street 1:1015 2ND ST
Practice Address - Street 2:UNIT 109
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-3641
Practice Address - Country:US
Practice Address - Phone:256-659-8473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-19
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21910235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist