MEDICARE: KIMBERLY RAY

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
1	235Z00000X	Speech-Language Pathologist
2	235Z00000X	Speech-Language Pathologist		AZ

General Provider Information

NPI Number	:	1912253485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY RAY

Provider Business Mailing Address
First Line	:	1681 E VILLAGE GREEN RD
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-2813
Country	:	US
Telephone Number	:	661-607-2756
Fax Number	:

Provider Business Practice Location Address
First Line	:	1681 E VILLAGE GREEN RD
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-2813
Country	:	US
Telephone Number	:	661-607-2756
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2012
Last Update Date	:	09/18/2019

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Directions to “ KIMBERLY RAY ” Practice Location

Language	Start Address	Practice Location

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