Provider Demographics
NPI:1003031014
Name:RAY, CAROL L (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:L
Last Name:RAY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 30TH AVE W
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98199-2735
Mailing Address - Country:US
Mailing Address - Phone:206-282-5839
Mailing Address - Fax:
Practice Address - Street 1:4507 SUNNYSIDE AVE N
Practice Address - Street 2:UNIT D
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6954
Practice Address - Country:US
Practice Address - Phone:206-849-3937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00002837235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6466RAOtherREGENCE RIDER NUMBER
WA3646RAOtherREGENCE RIDER NUMBER