Provider Demographics
NPI:1104195130
Name:GARLOCK, MARY ANN
Entity Type:Individual
Prefix:MRS
First Name:MARY ANN
Middle Name:
Last Name:GARLOCK
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 1:189 ELM ST
Mailing Address - Street 2:POBOX 426
Mailing Address - City:SPRINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14141-1503
Mailing Address - Country:US
Mailing Address - Phone:716-592-9536
Mailing Address - Fax:
Practice Address - Street 1:290 NORTH BUFFALO ST
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:14141
Practice Address - Country:US
Practice Address - Phone:716-592-9536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-20
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003936235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist