Provider Demographics
NPI:1821631235
Name:RAY, STEFANIE (SLP)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8910 PURDUE RD STE 700
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6136
Mailing Address - Country:US
Mailing Address - Phone:800-603-6046
Mailing Address - Fax:
Practice Address - Street 1:200 ONE NINETEEN BLVD
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35242-7236
Practice Address - Country:US
Practice Address - Phone:800-603-6046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-18
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5165235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist