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General NPI Number Information
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NPI Number | 1275721474
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Entity Type | Individual
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Provider Name | TERESA LYNN GRAY M.A. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 10/12/2007
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Last Update Date | 10/12/2007
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Provider Practice Location Address
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Address Line | 7110 JORDAN DR
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City | RAPID CITY
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State | SD
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Zip | 57702-8738
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Country | US
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Telephone | 605-342-4412
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Fax | 605-342-4211
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Provider Business Mailing Address
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Address Line | 7110 JORDAN DR
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City | RAPID CITY
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State | SD
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Zip | 57702-8738
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Country | US
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Telephone | 605-342-4412
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Fax | 605-342-4211
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 50972-02
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License Number State | SD
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