Provider Demographics
NPI:1326193111
Name:CALLOW, MARY M (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:CALLOW
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:853 NEWBURY NECK RD
Mailing Address - Street 2:
Mailing Address - City:SURRY
Mailing Address - State:ME
Mailing Address - Zip Code:04684-3710
Mailing Address - Country:US
Mailing Address - Phone:207-667-1740
Mailing Address - Fax:
Practice Address - Street 1:190 BANGOR RD
Practice Address - Street 2:SUITE A
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-3258
Practice Address - Country:US
Practice Address - Phone:207-667-7108
Practice Address - Fax:207-664-0461
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEME260700235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME034994OtherANTHEM
ME2372663OtherAETNA HMO
ME7714153OtherAETNA NON-HMO