Provider Demographics
NPI:1639453889
Name:RAY, DAWN MARIE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:RAY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 ORCHARDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-4552
Mailing Address - Country:US
Mailing Address - Phone:518-383-4735
Mailing Address - Fax:
Practice Address - Street 1:1 ARBOR DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12207-1310
Practice Address - Country:US
Practice Address - Phone:518-475-6626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-06
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004898235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist