Healthcare Provider Details

I. General information

NPI: 1609839604
Provider Name (Legal Business Name): MARY SACCHET GRAY MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 VETERANS DR
LEXINGTON KY
40502-2235
US

IV. Provider business mailing address

4500 MARWOOD DR
LEXINGTON KY
40515-4739
US

V. Phone/Fax

Practice location:
  • Phone: 859-281-4972
  • Fax: 859-281-4978
Mailing address:
  • Phone: 859-273-8075
  • Fax: 859-281-4978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number0472
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: