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General NPI Number Information
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NPI Number | 1043504657
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Entity Type | Organization
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Legal Business Name | AMY RAY, PH.D., P.C.
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Dates
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Enumeration Date | 06/01/2011
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Last Update Date | 06/01/2011
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Provider Practice Location Address
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Address Line | 350 HOUBOLT RD SUITE 202
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City | JOLIET
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State | IL
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Zip | 60431-8305
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Country | US
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Telephone | 815-553-0788
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Fax | 815-553-0789
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Provider Business Mailing Address
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Address Line | 507 BIRCH DR
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City | SHOREWOOD
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State | IL
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Zip | 60404-9740
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Country | US
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Telephone | 815-553-0788
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Fax | 815-553-0789
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | DR. AMY LEANDRA RAY
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Credential | PH.D.
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Telephone | 815-553-0788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 071005955
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License Number State | IL
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