Provider Demographics
NPI:1225368228
Name:RAY, AMY LEANDRA (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:LEANDRA
Last Name:RAY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 HOUBOLT RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431-8305
Mailing Address - Country:US
Mailing Address - Phone:815-553-0788
Mailing Address - Fax:815-553-0789
Practice Address - Street 1:350 HOUBOLT RD STE 202
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-8305
Practice Address - Country:US
Practice Address - Phone:815-553-0788
Practice Address - Fax:815-553-0789
Is Sole Proprietor?:No
Enumeration Date:2010-01-13
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005955103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical