Provider Demographics
NPI:1720196595
Name:RAY, MISTY C (BS)
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:C
Last Name:RAY
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15103 ALEXANDER RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER
Mailing Address - State:AR
Mailing Address - Zip Code:72002-1512
Mailing Address - Country:US
Mailing Address - Phone:501-259-6999
Mailing Address - Fax:501-407-8053
Practice Address - Street 1:121 COX ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-4611
Practice Address - Country:US
Practice Address - Phone:501-776-0691
Practice Address - Fax:501-776-0692
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP2352235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist