Provider Demographics
NPI:1225373368
Name:RAY, JAYANTI (PHD)
Entity Type:Individual
Prefix:
First Name:JAYANTI
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:PROF
Other - First Name:JAYANTI
Other - Middle Name:SAMANTA
Other - Last Name:RAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:250 BRANDY LN
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-8443
Mailing Address - Country:US
Mailing Address - Phone:573-339-0911
Mailing Address - Fax:
Practice Address - Street 1:250 BRANDY LN
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-8443
Practice Address - Country:US
Practice Address - Phone:573-339-0911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004020293235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist