Provider Demographics
NPI:1326242645
Name:REEVES, MARY DIANE (TEACHER CERTIFICATE)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:DIANE
Last Name:REEVES
Suffix:
Gender:F
Credentials:TEACHER CERTIFICATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19805 STATE HWY C
Mailing Address - Street 2:BOX 370
Mailing Address - City:ADVANCE
Mailing Address - State:MO
Mailing Address - Zip Code:63730
Mailing Address - Country:US
Mailing Address - Phone:573-722-3564
Mailing Address - Fax:573-722-9886
Practice Address - Street 1:19805 STATE HWY C
Practice Address - Street 2:BOX 370
Practice Address - City:ADVANCE
Practice Address - State:MO
Practice Address - Zip Code:63730
Practice Address - Country:US
Practice Address - Phone:573-722-3564
Practice Address - Fax:573-722-9886
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist