Healthcare Provider Details

I. General information

NPI: 1073429304
Provider Name (Legal Business Name): ALEXANDRIA GRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 EZZARD CHARLES DR
CINCINNATI OH
45214-2806
US

IV. Provider business mailing address

1223 ROSSMORE AVE
CINCINNATI OH
45237-5215
US

V. Phone/Fax

Practice location:
  • Phone: 567-454-7905
  • Fax:
Mailing address:
  • Phone: 567-454-7905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP.16962
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: