Provider Demographics
NPI:1275042830
Name:LANGLOOIS, MARY ANE
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANE
Last Name:LANGLOOIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 CENTRAL SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63304-7113
Mailing Address - Country:US
Mailing Address - Phone:636-851-4067
Mailing Address - Fax:636-851-4094
Practice Address - Street 1:4545 CENTRAL SCHOOL RD
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63304-7113
Practice Address - Country:US
Practice Address - Phone:636-851-4067
Practice Address - Fax:636-851-4094
Is Sole Proprietor?:No
Enumeration Date:2017-09-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist