Provider Demographics
NPI:1740468081
Name:RAKESTRAW, MARY ALLISON ORMON (ST)
Entity type:Individual
Prefix:
First Name:MARY ALLISON
Middle Name:ORMON
Last Name:RAKESTRAW
Suffix:
Gender:F
Credentials:ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 BECK SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:HICKORY FLAT
Mailing Address - State:MS
Mailing Address - Zip Code:38633-9184
Mailing Address - Country:US
Mailing Address - Phone:662-668-0612
Mailing Address - Fax:
Practice Address - Street 1:913 BECK SPRINGS RD
Practice Address - Street 2:
Practice Address - City:HICKORY FLAT
Practice Address - State:MS
Practice Address - Zip Code:38633-9184
Practice Address - Country:US
Practice Address - Phone:662-668-0612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-08
Last Update Date:2014-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS2821235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist