Healthcare Provider Details

I. General information

NPI: 1124937743
Provider Name (Legal Business Name): STEPHANIE JO RAY M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE JO RAY M.A., CCC-SLP

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4340 WALZ RD
JACKSON MI
49201-9614
US

IV. Provider business mailing address

6700 BROWNS LAKE RD
JACKSON MI
49201-8379
US

V. Phone/Fax

Practice location:
  • Phone: 517-764-1810
  • Fax: 517-764-6085
Mailing address:
  • Phone: 517-768-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101001397
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: