Provider Demographics
NPI:1043543101
Name:KENT, MARY M (MED, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:KENT
Suffix:
Gender:F
Credentials:MED, 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:PO BOX 2837
Mailing Address - Street 2:
Mailing Address - City:WEST HELENA
Mailing Address - State:AR
Mailing Address - Zip Code:72390-0837
Mailing Address - Country:US
Mailing Address - Phone:870-338-6461
Mailing Address - Fax:870-338-8442
Practice Address - Street 1:908 VANDERBILT AVE
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-5133
Practice Address - Country:US
Practice Address - Phone:870-732-8562
Practice Address - Fax:870-732-8562
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR09124807235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist