Provider Demographics
NPI:1780883579
Name:RAY, GEORGINE (AUD)
Entity type:Individual
Prefix:
First Name:GEORGINE
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 E SHEA BLVD
Mailing Address - Street 2:STE 174
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3061
Mailing Address - Country:US
Mailing Address - Phone:602-254-6041
Mailing Address - Fax:602-254-6735
Practice Address - Street 1:4638 E SHEA BLVD
Practice Address - Street 2:SUITE B-170
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3072
Practice Address - Country:US
Practice Address - Phone:602-254-6041
Practice Address - Fax:602-254-6735
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA719231H00000X, 231HA2400X, 231HA2500X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NGBBSMedicare PIN