Provider Demographics
NPI:1003318973
Name:PAINTER, MARY KATHARINE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATHARINE
Last Name:PAINTER
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 1:515 ROCKINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2622
Mailing Address - Country:US
Mailing Address - Phone:610-468-6068
Mailing Address - Fax:
Practice Address - Street 1:220 LONGMIRE RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:TN
Practice Address - Zip Code:37716-7338
Practice Address - Country:US
Practice Address - Phone:865-457-6925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSP0000005250235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist