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 1:2895 FACILITIES WAY
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-0034
Practice Address - Country:US
Practice Address - Phone:972-883-3630
Practice Address - Fax:972-883-3022
Is Sole Proprietor?:No
Enumeration Date:2022-04-17
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19790235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist