Healthcare Provider Details

I. General information

NPI: 1285117762
Provider Name (Legal Business Name): ANASTAZIA JUSZCZAK GRAY MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2018
Last Update Date: 09/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 N. CHURCH ST
GREENSBORO NC
27401
US

IV. Provider business mailing address

111 S. RAILROAD AVE
DUNN NC
28334
US

V. Phone/Fax

Practice location:
  • Phone: 336-358-5100
  • Fax:
Mailing address:
  • Phone: 910-892-0027
  • Fax: 910-892-0094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number10826
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: