Provider Demographics
NPI:1407099864
Name:MCDEVITT KRALJIC, MARY AGNES (MS CCC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:AGNES
Last Name:MCDEVITT KRALJIC
Suffix:
Gender:F
Credentials:MS CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10159 201ST AVE NW
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-2049
Mailing Address - Country:US
Mailing Address - Phone:763-441-6229
Mailing Address - Fax:
Practice Address - Street 1:10159 201ST AVE NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-2049
Practice Address - Country:US
Practice Address - Phone:763-441-6229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7837235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist