Individual provider Active NPI

Molly Gray

  • Speech-Language Pathologist
  • Zachary, LA
National Provider Identifier
1568209369
Registry record updated Jul 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
9677 Issued in NU
Practice address
4845 Church Street
Suite B
Zachary, LA 70791
Phone
(225) 654-8208
NPI assigned
Jul 10, 2024
Last updated
Jul 10, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 9677 NU Primary

Addresses

Primary practice location

4845 Church Street
Suite B
Zachary, LA 70791

Mailing address

4324 S Sherwood Forest Blvd Ste B170
Baton Rouge, LA 70816-4481
Phone (225) 654-8208

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240826000596 LA Practitioner - Qualified Speech Language Pathologist 2567901390 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
9677LAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Moreau Physical Therapy Inc. Speech-Language Pathologist CurrentSince Jun 25, 2024 Accepting new patients
Alvin C Moreau Jr Licensed Physical Therapist DTD 01 15 82 CurrentSince Jun 25, 2024 Accepting new patients

Locations

11424 Sullivan Rd
#A-C
Baton Rouge, LA 70818
Phone (225) 261-7021

4324 S Sherwood Frst
Ste B170
Baton Rouge, LA 70816

4845 Main St
#B
Zachary, LA 70791
Phone (225) 238-2955

4845 Main St
#C
Zachary, LA 70791
Phone (225) 286-0181

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1720569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720569600000",
    "number": "1568209369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4324 S SHERWOOD FOREST BLVD STE B170",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708164481",
            "telephone_number": "225-654-8208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4845 CHURCH STREET",
            "address_2": "SUITE B",
            "city": "ZACHARY",
            "state": "LA",
            "postal_code": "70791",
            "telephone_number": "225-654-8208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAY",
        "first_name": "MOLLY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-10",
        "last_updated": "2024-07-10",
        "certification_date": "2024-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": "9677",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Zachary, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.