Provider Demographics
NPI:1225653835
Name:POLLOK, MARY MADDIE (AUD FAAA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MADDIE
Last Name:POLLOK
Suffix:
Gender:F
Credentials:AUD FAAA
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ALLEN
Other - Last Name:MADDIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD FAAA
Mailing Address - Street 1:245 W STATE HIGHWAY 114 STE 120
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-3637
Mailing Address - Country:US
Mailing Address - Phone:817-591-7155
Mailing Address - Fax:
Practice Address - Street 1:245 W STATE HIGHWAY 114 STE 120
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-3637
Practice Address - Country:US
Practice Address - Phone:817-591-7155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX231H00000X
TX81274237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter