Provider Demographics
NPI:1346327012
Name:KEY, MARY (MA, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:KEY
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 1:576 WHITE MILLS GLENDALE RD E
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:KY
Mailing Address - Zip Code:42740-7702
Mailing Address - Country:US
Mailing Address - Phone:270-369-8499
Mailing Address - Fax:
Practice Address - Street 1:576 WHITE MILLS GLENDALE RD E
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:KY
Practice Address - Zip Code:42740-7702
Practice Address - Country:US
Practice Address - Phone:270-369-8499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1465235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist