Provider Demographics
NPI:1336635713
Name:PERI, MARY PAT MCGUIRE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARY PAT
Middle Name:MCGUIRE
Last Name:PERI
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9909 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032-1013
Mailing Address - Country:US
Mailing Address - Phone:703-850-8248
Mailing Address - Fax:
Practice Address - Street 1:9909 LAUREL ST
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22032-1013
Practice Address - Country:US
Practice Address - Phone:703-850-8248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202002825235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist