Provider Demographics
NPI:1336530609
Name:RAY, SUSAN MICHELLE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MICHELLE
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 1:1177 N. WARSON RD.
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132
Mailing Address - Country:US
Mailing Address - Phone:314-269-2211
Mailing Address - Fax:314-569-0778
Practice Address - Street 1:1177 N. WARSON RD.
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132
Practice Address - Country:US
Practice Address - Phone:314-269-2211
Practice Address - Fax:314-569-0778
Is Sole Proprietor?:No
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014023327235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist