Provider Demographics
NPI:1326503004
Name:MACPHERSON, MARY (MA (SPEECH LANGUAG)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:MACPHERSON
Suffix:
Gender:F
Credentials:MA (SPEECH LANGUAG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 CENTRAL AVE.
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501
Mailing Address - Country:US
Mailing Address - Phone:510-499-5437
Mailing Address - Fax:
Practice Address - Street 1:2308 CENTRAL AVE.
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501
Practice Address - Country:US
Practice Address - Phone:510-499-5437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP004832235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist