Individual
MRS. JENNIFER GRAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
414 E BURDICK RD, CHESTERTON, IN 46304-9527
(317) 698-1057
Mailing address
PO BOX 2723, CHESTERTON, IN 46304-5823
(317) 698-1057
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200816420
FIRST STEPS PROVIDER #
IN
Enumeration date
04/06/2007
Last updated
01/24/2019
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