Provider Demographics
NPI:1376881235
Name:CACY, MARY BETTY (MED)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:BETTY
Last Name:CACY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 NW 22ND ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-1618
Mailing Address - Country:US
Mailing Address - Phone:405-820-5012
Mailing Address - Fax:
Practice Address - Street 1:2020 NW 22ND ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-1618
Practice Address - Country:US
Practice Address - Phone:405-820-5012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-27
Last Update Date:2013-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK520235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist