Healthcare Provider Details

I. General information

NPI: 1447055231
Provider Name (Legal Business Name): EMILY RAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2025
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3721 23RD ST S
SAINT CLOUD MN
56301-6198
US

IV. Provider business mailing address

1105 W RUSSELL ST
SIOUX FALLS SD
57104-1322
US

V. Phone/Fax

Practice location:
  • Phone: 605-271-2690
  • Fax: 605-271-3956
Mailing address:
  • Phone: 605-271-2690
  • Fax: 605-271-3956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-488424
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: