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General NPI Number Information
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NPI Number | 1225907389
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Entity Type | Individual
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Provider Name | JACQUELINE GRAY MT-BC
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Gender | Female
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Dates
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Enumeration Date | 11/05/2025
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Last Update Date | 11/05/2025
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Provider Practice Location Address
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Address Line | 800 ZORN AVE
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City | LOUISVILLE
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State | KY
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Zip | 40206-1433
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Country | US
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Telephone | 706-551-3656
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Fax |
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Provider Business Mailing Address
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Address Line | 3058 BARDSTOWN RD # 1039
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City | LOUISVILLE
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State | KY
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Zip | 40205-3020
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Country | US
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Telephone | 706-551-3656
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Fax |
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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 | 225A00000X
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Taxonomy Name | Music Therapist
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License Number | 13805
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License Number State |
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