Provider Demographics
NPI:1891424057
Name:PERRY, RAYSHONDA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RAYSHONDA
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 ROSEBERRY LN APT 2321
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-2869
Mailing Address - Country:US
Mailing Address - Phone:803-718-6632
Mailing Address - Fax:
Practice Address - Street 1:2555 KINARD ST
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:SC
Practice Address - Zip Code:29108-2903
Practice Address - Country:US
Practice Address - Phone:803-276-6060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-05
Last Update Date:2022-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7291235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist