Provider Demographics
NPI:1174671408
Name:PARKER, MARYPAT (MA CCC-SLP-L)
Entity Type:Individual
Prefix:MS
First Name:MARYPAT
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:MA CCC-SLP-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 CLIFF RD E
Mailing Address - Street 2:APARTMENT # 322
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-1350
Mailing Address - Country:US
Mailing Address - Phone:952-707-1939
Mailing Address - Fax:
Practice Address - Street 1:1515 SAINT FRANCIS AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-3387
Practice Address - Country:US
Practice Address - Phone:952-403-2019
Practice Address - Fax:952-403-3807
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7483235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist