Provider Demographics
NPI:1790206514
Name:AYRES, RAYCHAEL LANICE
Entity Type:Individual
Prefix:
First Name:RAYCHAEL
Middle Name:LANICE
Last Name:AYRES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 MCMILLAN CT UNIT 202
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60112-4178
Mailing Address - Country:US
Mailing Address - Phone:815-901-6815
Mailing Address - Fax:
Practice Address - Street 1:313 GURLER ST APT 6
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-3661
Practice Address - Country:US
Practice Address - Phone:815-748-8544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-30
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator