Provider Demographics
NPI:1215221130
Name:MASLYN, MARY LISA (SPEECH LANGUAGE PATH)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LISA
Last Name:MASLYN
Suffix:
Gender:F
Credentials:SPEECH LANGUAGE PATH
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:LISA
Other - Last Name:CORNWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SPEECH LANGUAGE PATH
Mailing Address - Street 1:703 E. MAPLE AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513
Mailing Address - Country:US
Mailing Address - Phone:315-331-1700
Mailing Address - Fax:
Practice Address - Street 1:703 E. MAPLE AVENUE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513
Practice Address - Country:US
Practice Address - Phone:315-331-1700
Practice Address - Fax:315-331-9233
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003070-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist