Provider Demographics
NPI:1053877605
Name:RAY, SANDRA (SLP)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:RAY
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 1:120 KILLIAN POINT CIR
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036-8223
Mailing Address - Country:US
Mailing Address - Phone:803-603-7796
Mailing Address - Fax:
Practice Address - Street 1:105 FARNSLEIGH AVE
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-7957
Practice Address - Country:US
Practice Address - Phone:727-505-3677
Practice Address - Fax:843-594-4084
Is Sole Proprietor?:No
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6756235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist