Provider Demographics
NPI:1447546346
Name:RAY, LORA KNOWLES (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LORA
Middle Name:KNOWLES
Last Name:RAY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 BURTOM RD
Mailing Address - Street 2:
Mailing Address - City:EATONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31024-7050
Mailing Address - Country:US
Mailing Address - Phone:770-780-9244
Mailing Address - Fax:
Practice Address - Street 1:299 BURTOM RD
Practice Address - Street 2:
Practice Address - City:EATONTON
Practice Address - State:GA
Practice Address - Zip Code:31024-7050
Practice Address - Country:US
Practice Address - Phone:770-780-9244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5069235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist