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NPI Code Detail

MEDICARE: MS. JENNY LEIGH GRAY B.S.W.

MEDICARE:  MS. JENNY LEIGH GRAY  B.S.W.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker2009038382MO

General Provider Information

NPI Number : 1184753105
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JENNY LEIGH GRAY B.S.W.
Provider Business Mailing Address
First Line : 1611 TOWNE DR
Second Line :
City : COLUMBIA
State : MO
Zip : 65202-2339
Country : US
Telephone Number : 573-474-6660
Fax Number : 573-474-5992
Provider Business Practice Location Address
First Line : 1611 TOWNE DR
Second Line :
City : COLUMBIA
State : MO
Zip : 65202-2339
Country : US
Telephone Number : 573-474-6660
Fax Number : 573-474-5992
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2007
Last Update Date : 04/05/2010

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Directions to “ MS. JENNY LEIGH GRAY B.S.W.” Practice Location

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