Provider Demographics
NPI:1275068900
Name:RALEY, TASHANA
Entity Type:Individual
Prefix:
First Name:TASHANA
Middle Name:
Last Name:RALEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 PENINSULA CT
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-2622
Mailing Address - Country:US
Mailing Address - Phone:704-654-8599
Mailing Address - Fax:980-938-6088
Practice Address - Street 1:11201 LIVINGSTON MILL RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-4720
Practice Address - Country:US
Practice Address - Phone:704-654-8599
Practice Address - Fax:980-938-6088
Is Sole Proprietor?:No
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist