Provider Demographics
NPI:1235430455
Name:RAY, MERRITT MARTIN
Entity Type:Individual
Prefix:
First Name:MERRITT
Middle Name:MARTIN
Last Name:RAY
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 1:203 NORTH MAPLE STREET
Mailing Address - Street 2:SUITE 10
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681
Mailing Address - Country:US
Mailing Address - Phone:864-757-9846
Mailing Address - Fax:864-757-9847
Practice Address - Street 1:203 N MAPLE STREET
Practice Address - Street 2:SUITE 10
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681
Practice Address - Country:US
Practice Address - Phone:864-757-9846
Practice Address - Fax:864-757-9847
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2377235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist