Provider Demographics
NPI:1568924405
Name:CORDRAY, MANDY KAY (CNA)
Entity Type:Individual
Prefix:MRS
First Name:MANDY
Middle Name:KAY
Last Name:CORDRAY
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 WOODLAWN RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:IL
Mailing Address - Zip Code:62656-9770
Mailing Address - Country:US
Mailing Address - Phone:217-735-3573
Mailing Address - Fax:217-735-5106
Practice Address - Street 1:1201 WOODLAWN RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:IL
Practice Address - Zip Code:62656-9770
Practice Address - Country:US
Practice Address - Phone:217-735-3573
Practice Address - Fax:217-735-5106
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0873237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist