Candice Moree Gray, M.A., CCC-S.L.P.
Individual provider Active NPI Speech-Language Pathologist · Geismar, LA
NPI 1811029101 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1811029101
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 4906 (LA)
- Practice address
- 10510 Shadowlake Dr
Geismar, LA 70734-3329 - Phone
- (225) 647-7221
- NPI assigned
- Mar 12, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4906 | LA | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 4906 | LA | Yes |
Addresses
Primary practice location
10510 Shadowlake Dr
Geismar, LA 70734-3329
Mailing address
10510 Shadowlake Dr
Geismar, LA 70734-3329
Phone (225) 647-7221
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1301078 | Medicaid | LA |
Other providers in Geismar, LA
- Willie Massey Farve
- Ashleigh Pipes Frederic
- Crayanchia Gabriel
- Kevin Lee Gatlin
- Kristin Lynn Gianfalla
- Gulf Coast Medical Transport LLC
- Jennifer Hardee
- Megan Catherine Hintz
- Jennifer Batrous Holley
- Denikka Latoya Hull
All providers in Geismar, LA · Speech-Language Pathologist in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.