Individual
TAMMY D GRAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1720 W FLORIST AVE STE 125, GLENDALE, WI 53209-3862
(414) 247-0801
(414) 247-0816
Mailing address
1720 W FLORIST AVE STE 125, GLENDALE, WI 53209-3862
(414) 247-0801
(414) 247-0816
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
131247
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
131243
LICENSE
WI
Enumeration date
10/10/2018
Last updated
10/10/2018
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