Provider Demographics
NPI:1396145827
Name:GRAY, BRANDY (MS,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:MISS
Other - First Name:BRANDY
Other - Middle Name:
Other - Last Name:WILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,CCC-SLP
Mailing Address - Street 1:12524 CAPELLA TRL
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78732-2394
Mailing Address - Country:US
Mailing Address - Phone:512-709-9420
Mailing Address - Fax:
Practice Address - Street 1:12524 CAPELLA TRL
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78732-2394
Practice Address - Country:US
Practice Address - Phone:512-709-9420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101203235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist