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Individual

MS. KESHELL ANTRON GRAY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.S., CCC-SLP

Contact information

Practice address
7160 TCHULAHOMA RD, BLDG. B SUITE 4, SOUTHAVEN, MS 38671-9266
(662) 349-2733
Mailing address
197 IRA RD, MOUND BAYOU, MS 38762-9708
(662) 741-2185

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
S3231
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
09015269
MS
Enumeration date
12/10/2008
Last updated
09/08/2018
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