Provider Demographics
NPI:1760529739
Name:RAY, ERICA D (AUD)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:D
Last Name:RAY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:ERICA
Other - Middle Name:L
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:220 S DEMANADE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2546
Mailing Address - Country:US
Mailing Address - Phone:337-704-1969
Mailing Address - Fax:
Practice Address - Street 1:110 EXCHANGE PL STE 100
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2510
Practice Address - Country:US
Practice Address - Phone:337-291-9939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3314231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1983756Medicaid
LA1983756Medicaid