Basic Information
| Provider Information | |||||||||
| NPI: | 1578002531 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WRAY | ||||||||
| FirstName: | STACIE | ||||||||
| MiddleName: | SCHIFANI | ||||||||
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| Credential: | M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 204 ASH ST | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722054008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9014128040 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9209 DOLLARWAY RD | ||||||||
| Address2: | |||||||||
| City: | WHITE HALL | ||||||||
| State: | AR | ||||||||
| PostalCode: | 716022616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702470800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2017 | ||||||||
| LastUpdateDate: | 02/22/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | P9072 | AR | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.