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NPI Code Detail

MEDICARE: ELIZABETH MARIE BRAY MS, CCC-SLP

MEDICARE: ELIZABETH MARIE BRAY MS, CCC-SLP
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 PathologistIL

General Provider Information

NPI Number : 1578040572
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH MARIE BRAY MS, CCC-SLP
Provider Business Mailing Address
First Line : 1312 MARY DR
Second Line :
City : EDWARDSVILLE
State : IL
Zip : 62025-4209
Country : US
Telephone Number : 618-659-3506
Fax Number :
Provider Business Practice Location Address
First Line : 708 SAINT LOUIS ST
Second Line :
City : EDWARDSVILLE
State : IL
Zip : 62025-1427
Country : US
Telephone Number : 618-656-1182
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/23/2018
Last Update Date : 07/23/2018

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Directions to “ ELIZABETH MARIE BRAY MS, CCC-SLP” Practice Location

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