Provider Demographics
NPI:1962205740
Name:RAY, LEANNE (RD)
Entity type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:RAY
Suffix:
Gender:
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3724 JEFFERSON ST STE 104
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-6204
Mailing Address - Country:US
Mailing Address - Phone:512-693-7045
Mailing Address - Fax:
Practice Address - Street 1:5 COTTAGEMILL CT
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MO
Practice Address - Zip Code:63021-6837
Practice Address - Country:US
Practice Address - Phone:786-281-1903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-28
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019020892133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered