Provider Demographics
NPI:1851439467
Name:RAY, KYNDA (MS CCC SLP)
Entity Type:Individual
Prefix:
First Name:KYNDA
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 N LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-5247
Mailing Address - Country:US
Mailing Address - Phone:618-599-0743
Mailing Address - Fax:
Practice Address - Street 1:636 N LAKE BLVD
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-5247
Practice Address - Country:US
Practice Address - Phone:618-599-0743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22002594A235Z00000X
FLSA14334235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL09632007Medicare UPIN