Provider Demographics
NPI:1083143796
Name:RAYFORD, VANESSA ANN
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:ANN
Last Name:RAYFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2924 KINGS RD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-2016
Mailing Address - Country:US
Mailing Address - Phone:850-348-1057
Mailing Address - Fax:850-254-2969
Practice Address - Street 1:700 W 23RD ST STE B-20
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-3936
Practice Address - Country:US
Practice Address - Phone:850-348-1057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician