Provider Demographics
NPI:1457676751
Name:RAY, LEAH W
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:W
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 1:102 WOODCHASE PARK DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-4113
Mailing Address - Country:US
Mailing Address - Phone:601-924-7043
Mailing Address - Fax:601-924-8633
Practice Address - Street 1:102 WOODCHASE PARK DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-4113
Practice Address - Country:US
Practice Address - Phone:601-924-7043
Practice Address - Fax:601-924-8633
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS2219235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist