Provider Demographics
NPI:1003478041
Name:DUPREE, RAVEN JAMAY
Entity Type:Individual
Prefix:MS
First Name:RAVEN
Middle Name:JAMAY
Last Name:DUPREE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 BAXLEY DR
Mailing Address - Street 2:
Mailing Address - City:MANNING
Mailing Address - State:SC
Mailing Address - Zip Code:29102-5673
Mailing Address - Country:US
Mailing Address - Phone:803-566-6746
Mailing Address - Fax:
Practice Address - Street 1:355 RIDGE RUN TRL
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-8667
Practice Address - Country:US
Practice Address - Phone:803-566-6746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-30
Last Update Date:2019-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6571235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist