MEDICARE: MRS. LISA J.C. RAYES 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
1	235Z00000X	Speech-Language Pathologist	132	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023135993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA J.C. RAYES CCC-SLP

Provider Business Mailing Address
First Line	:	11015 STEEPLE DR
Second Line	:
City	:	EAGLE RIVER
State	:	AK
Zip	:	99577-7122
Country	:	US
Telephone Number	:	907-770-1990
Fax Number	:

Provider Business Practice Location Address
First Line	:	4048 LAUREL ST STE 303
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-5391
Country	:	US
Telephone Number	:	907-562-4550
Fax Number	:

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

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	07/08/2007

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Directions to “ MRS. LISA J.C. RAYES CCC-SLP” Practice Location

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