Provider Demographics
NPI:1396008876
Name:POWERS, MARY BETH (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:POWERS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
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Other - First Name:
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Mailing Address - Street 1:1800 N WABASH RD STE 203
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-1300
Mailing Address - Country:US
Mailing Address - Phone:765-651-3229
Mailing Address - Fax:765-651-3227
Practice Address - Street 1:1800 N WABASH RD STE 203
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-1300
Practice Address - Country:US
Practice Address - Phone:765-651-3229
Practice Address - Fax:765-651-3227
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN22002370A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist