Provider Demographics
NPI:1477285690
Name:RAY, RAYVEN S
Entity Type:Individual
Prefix:
First Name:RAYVEN
Middle Name:S
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 1:111 W WACKER DR APT 1612
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-1606
Mailing Address - Country:US
Mailing Address - Phone:316-461-3401
Mailing Address - Fax:
Practice Address - Street 1:111 W WACKER DR APT 1612
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-1606
Practice Address - Country:US
Practice Address - Phone:316-461-3401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist