Provider Demographics
NPI:1407904659
Name:GAY, MARY LYNN (MACCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LYNN
Last Name:GAY
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5020 REED RD STE C
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2581
Mailing Address - Country:US
Mailing Address - Phone:614-204-5066
Mailing Address - Fax:
Practice Address - Street 1:5020 REED RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2581
Practice Address - Country:US
Practice Address - Phone:614-204-5066
Practice Address - Fax:614-654-5993
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-4241235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4279161Medicare PIN