Provider Demographics
NPI:1336570332
Name:RAMEY, MIA DECATO (SLP)
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:DECATO
Last Name:RAMEY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3608 W FRIENDLY AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-4833
Mailing Address - Country:US
Mailing Address - Phone:336-550-4933
Mailing Address - Fax:203-900-0221
Practice Address - Street 1:3608 W FRIENDLY AVE STE 108
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-4833
Practice Address - Country:US
Practice Address - Phone:336-550-4933
Practice Address - Fax:203-900-0221
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-02
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3923235Z00000X
NC13767235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1336570332Medicaid