Provider Demographics
NPI:1700944212
Name:WOODRUFF, RAYANNE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:RAYANNE
Middle Name:
Last Name:WOODRUFF
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 1:3021 LAKELAND HIGHLANDS RD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-4339
Mailing Address - Country:US
Mailing Address - Phone:863-688-5232
Mailing Address - Fax:863-688-4153
Practice Address - Street 1:3021 LAKELAND HIGHLANDS RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-4339
Practice Address - Country:US
Practice Address - Phone:863-688-5232
Practice Address - Fax:863-688-4153
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA4474235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686611Medicare ID - Type Unspecified