Provider Demographics
NPI:1376298216
Name:HARVEY, MABRY SPOTTSWOOD (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MABRY
Middle Name:SPOTTSWOOD
Last Name:HARVEY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:MABRY
Other - Middle Name:JOANNE MARY
Other - Last Name:SPOTTSWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:703 BRISCOE RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-4402
Mailing Address - Country:US
Mailing Address - Phone:251-591-4413
Mailing Address - Fax:205-638-5122
Practice Address - Street 1:1600 7TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1711
Practice Address - Country:US
Practice Address - Phone:205-638-6735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4518235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty