MEDICARE: GRACE ANN RAY

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	S-5228	MS

General Provider Information

NPI Number	:	1598629545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE ANN RAY

Provider Business Mailing Address
First Line	:	1405 W SUNFLOWER RD
Second Line	:
City	:	CLEVELAND
State	:	MS
Zip	:	38732-2404
Country	:	US
Telephone Number	:	662-545-1017
Fax Number	:

Provider Business Practice Location Address
First Line	:	1405 W SUNFLOWER RD
Second Line	:
City	:	CLEVELAND
State	:	MS
Zip	:	38732-2404
Country	:	US
Telephone Number	:	662-545-1017
Fax Number	:

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

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	12/15/2025

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Directions to “ GRACE ANN RAY ” Practice Location

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