Provider Demographics
NPI:1609655075
Name:RAY, MADELEINE BLAKE (MS/CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MADELEINE
Middle Name:BLAKE
Last Name:RAY
Suffix:
Gender:F
Credentials:MS/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BRADY DR
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-2220
Mailing Address - Country:US
Mailing Address - Phone:304-972-6140
Mailing Address - Fax:
Practice Address - Street 1:100 BRADY DR
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-2220
Practice Address - Country:US
Practice Address - Phone:304-972-6140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2412235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist