Provider Demographics
NPI:1316371883
Name:RAY, BRIGETTE ELIZABETH
Entity type:Individual
Prefix:
First Name:BRIGETTE
Middle Name:ELIZABETH
Last Name:RAY
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 1:2156 W SUNNYSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-1626
Mailing Address - Country:US
Mailing Address - Phone:773-972-3301
Mailing Address - Fax:
Practice Address - Street 1:2156 W SUNNYSIDE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-1626
Practice Address - Country:US
Practice Address - Phone:773-972-3301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-02
Last Update Date:2013-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist