Provider Demographics
NPI:1053665349
Name:LERAY, TAMIKA REYNOLD (MS CCC SLP)
Entity Type:Individual
Prefix:
First Name:TAMIKA
Middle Name:REYNOLD
Last Name:LERAY
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4639 TOWNE PARK RD UNIT 1
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-1608
Mailing Address - Country:US
Mailing Address - Phone:202-594-9321
Mailing Address - Fax:
Practice Address - Street 1:4639 TOWNE PARK RD
Practice Address - Street 2:
Practice Address - City:SUITLAND
Practice Address - State:MD
Practice Address - Zip Code:20746-1608
Practice Address - Country:US
Practice Address - Phone:202-594-9321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-08
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8539235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist