Healthcare Provider Details

I. General information

NPI: 1093628810
Provider Name (Legal Business Name): SYDNEY KATHERINE GRAY
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 W 7TH ST STE 203
LONDON KY
40741-1763
US

IV. Provider business mailing address

253 W LAUREL RD
LONDON KY
40741-8133
US

V. Phone/Fax

Practice location:
  • Phone: 606-224-3400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number311191
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: