Healthcare Provider Details

I. General information

NPI: 1265019772
Provider Name (Legal Business Name): DELAYNE MOULTON GRAY M.S, SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 12/22/2022
Certification Date: 12/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3031 S RUSSELL ST STE B
MISSOULA MT
59801-8523
US

IV. Provider business mailing address

2500 SCHILLING ST
MISSOULA MT
59801-7520
US

V. Phone/Fax

Practice location:
  • Phone: 406-396-4130
  • Fax: 406-797-5008
Mailing address:
  • Phone: 406-240-8091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP-SP-LIC-9647
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: