Healthcare Provider Details

I. General information

NPI: 1417453994
Provider Name (Legal Business Name): KELLI GRAY MSW LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 OLD MILL RD
TOLEDO OH
43615-3022
US

IV. Provider business mailing address

2111 OLD MILL RD
TOLEDO OH
43615-3022
US

V. Phone/Fax

Practice location:
  • Phone: 567-868-8316
  • Fax:
Mailing address:
  • Phone: 567-868-8316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2512773
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: