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NPI Code Detail

MEDICARE: MS. SHAWNESSA LATRICE RAY M.S. CFY

MEDICARE: MS. SHAWNESSA LATRICE RAY M.S. CFY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language PathologistAR

General Provider Information

NPI Number : 1467861666
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SHAWNESSA LATRICE RAY M.S. CFY
Provider Business Mailing Address
First Line : 454 STURGIS RD
Second Line :
City : CONWAY
State : AR
Zip : 72034-8008
Country : US
Telephone Number : 501-470-1230
Fax Number :
Provider Business Practice Location Address
First Line : 9417 GEYER SPRINGS RD
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72209-7850
Country : US
Telephone Number : 501-447-2100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2014
Last Update Date : 08/13/2014

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Directions to “ MS. SHAWNESSA LATRICE RAY M.S. CFY” Practice Location

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