Provider Demographics
NPI:1902918337
Name:BRAY, MINNIE J (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MINNIE
Middle Name:J
Last Name:BRAY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2966 SE IRWIN RD
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:MO
Mailing Address - Zip Code:64429-9348
Mailing Address - Country:US
Mailing Address - Phone:816-449-5359
Mailing Address - Fax:
Practice Address - Street 1:3303 FREDERICK AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-2985
Practice Address - Country:US
Practice Address - Phone:816-364-3836
Practice Address - Fax:816-390-8546
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003024605235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO33092012OtherBLUE CROSS BLUE SHIELD