MEDICARE: MARY GRAY

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
1	235Z00000X	Speech-Language Pathologist	SP 10707	OH

General Provider Information

NPI Number	:	1326449406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY GRAY

Provider Business Mailing Address
First Line	:	305 MALACCA ST
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44305-3651
Country	:	US
Telephone Number	:	330-957-9992
Fax Number	:

Provider Business Practice Location Address
First Line	:	19800 STAFFORD AVE
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-1829
Country	:	US
Telephone Number	:	216-438-6000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2014
Last Update Date	:	05/23/2019

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Directions to “ MARY GRAY ” Practice Location

Language	Start Address	Practice Location

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