Provider Demographics
NPI:1023577384
Name:MCCAGHREN BRAY, KACIA KRISTIN (PHD, CCC-SLP)
Entity type:Individual
Prefix:DR
First Name:KACIA
Middle Name:KRISTIN
Last Name:MCCAGHREN BRAY
Suffix:
Gender:F
Credentials:PHD, CCC-SLP
Other - Prefix:DR
Other - First Name:KACIA
Other - Middle Name:KRISTIN
Other - Last Name:MCCAGHREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, CCC-SLP
Mailing Address - Street 1:301 MAGG SMITH RD
Mailing Address - Street 2:
Mailing Address - City:POLLOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28573-5904
Mailing Address - Country:US
Mailing Address - Phone:850-516-4037
Mailing Address - Fax:
Practice Address - Street 1:301 MAGG SMITH RD
Practice Address - Street 2:
Practice Address - City:POLLOCKSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28573-5904
Practice Address - Country:US
Practice Address - Phone:850-516-4037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-17
Last Update Date:2019-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7870235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist