Provider Demographics
NPI:1376539676
Name:NOLAND, MARY E (MBA, MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:NOLAND
Suffix:
Gender:F
Credentials:MBA, 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:PO BOX 760
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-0760
Mailing Address - Country:US
Mailing Address - Phone:602-578-0515
Mailing Address - Fax:602-237-7791
Practice Address - Street 1:5205 W WINSTON DR
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-2819
Practice Address - Country:US
Practice Address - Phone:602-578-0515
Practice Address - Fax:602-237-7791
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP 2151235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist