Provider Demographics
NPI:1790984615
Name:RAY-ALLEN, MARY ANNEZ (MED, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANNEZ
Last Name:RAY-ALLEN
Suffix:
Gender:F
Credentials:MED, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13966 ELAM CIR
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35475-3574
Mailing Address - Country:US
Mailing Address - Phone:205-333-9097
Mailing Address - Fax:
Practice Address - Street 1:700 UNIVERSITY BLVD E
Practice Address - Street 2:ROOM 145
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-2028
Practice Address - Country:US
Practice Address - Phone:205-348-1834
Practice Address - Fax:205-348-1845
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2649235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist