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General NPI Number Information
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NPI Number | 1184753105
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Entity Type | Individual
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Provider Name | JENNY LEIGH GRAY B.S.W.
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Gender | Female
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 04/05/2010
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Provider Practice Location Address
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Address Line | 1611 TOWNE DR
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City | COLUMBIA
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State | MO
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Zip | 65202-2339
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Country | US
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Telephone | 573-474-6660
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Fax | 573-474-5992
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Provider Business Mailing Address
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Address Line | 1611 TOWNE DR
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City | COLUMBIA
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State | MO
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Zip | 65202-2339
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Country | US
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Telephone | 573-474-6660
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Fax | 573-474-5992
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2009038382
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License Number State | MO
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