Provider Demographics
NPI:1225391501
Name:SCHIAVONI, MARY E (MS CCC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:SCHIAVONI
Suffix:
Gender:F
Credentials:MS CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 BURNHAM RD
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-9346
Mailing Address - Country:US
Mailing Address - Phone:207-284-9978
Mailing Address - Fax:207-799-2289
Practice Address - Street 1:77 BURNHAM RD
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-9346
Practice Address - Country:US
Practice Address - Phone:207-284-9978
Practice Address - Fax:207-799-2289
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP957235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist