Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PY01188 | MO |
Y | 103T00000X | Psychologist | PY01188 | MO |
NPI | 1013050194 |
---|---|
Provider Name | Mr. Sandra S Gray |
First Address | Kansas City, MO 64114-2034 |
Second Address | Kansas City, MO 64114-2034 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2007 |
Last Update Date | 08/07/2007 |