Provider Demographics
NPI:1205185246
Name:KRAMER, MARY MICHAELA (MA, R-SLP, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:MARY
Middle Name:MICHAELA
Last Name:KRAMER
Suffix:
Gender:F
Credentials:MA, R-SLP, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 N RICHARD JACKSON BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32407-2521
Mailing Address - Country:US
Mailing Address - Phone:850-235-6360
Mailing Address - Fax:850-235-8871
Practice Address - Street 1:120 N RICHARD JACKSON BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407-2521
Practice Address - Country:US
Practice Address - Phone:850-235-6360
Practice Address - Fax:850-235-8871
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA11502235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist