Provider Demographics
NPI:1407862683
Name:POOLE, MARY L (MS)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:L
Last Name:POOLE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 STADIUM MALL DRIVE
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47907-2052
Mailing Address - Country:US
Mailing Address - Phone:765-496-1927
Mailing Address - Fax:765-496-1227
Practice Address - Street 1:500 OVAL DRIVE
Practice Address - Street 2:1353 HEAVILON HALL
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47907-2038
Practice Address - Country:US
Practice Address - Phone:765-494-3823
Practice Address - Fax:765-494-0771
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22002310A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist