Provider Demographics
NPI:1578002531
Name:WRAY, STACIE SCHIFANI (MS)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:SCHIFANI
Last Name:WRAY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 ASH ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-4008
Mailing Address - Country:US
Mailing Address - Phone:901-412-8040
Mailing Address - Fax:
Practice Address - Street 1:9209 DOLLARWAY RD
Practice Address - Street 2:
Practice Address - City:WHITE HALL
Practice Address - State:AR
Practice Address - Zip Code:71602-2616
Practice Address - Country:US
Practice Address - Phone:870-247-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP9072235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist