MEDICARE: MS. SHAWNESSA LATRICE RAY M.S. CFY

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		AR

General Provider Information

NPI Number	:	1467861666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHAWNESSA LATRICE RAY M.S. CFY

Provider Business Mailing Address
First Line	:	454 STURGIS RD
Second Line	:
City	:	CONWAY
State	:	AR
Zip	:	72034-8008
Country	:	US
Telephone Number	:	501-470-1230
Fax Number	:

Provider Business Practice Location Address
First Line	:	9417 GEYER SPRINGS RD
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72209-7850
Country	:	US
Telephone Number	:	501-447-2100
Fax Number	:

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

Provider Enumeration Date	:	08/13/2014
Last Update Date	:	08/13/2014

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Language	Start Address	Practice Location

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