Individual
JACKSON GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
1750 E FAIRMOUNT AVE, BALTIMORE, MD 21231-1534
(920) 621-7263
Mailing address
2809 BOSTON ST APT 123, BALTIMORE, MD 21224-4815
(920) 621-7263
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
06711
MD
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/23/2020
Last updated
08/11/2022
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