Provider Demographics
NPI:1417367947
Name:GIBBONS, MARY E (MME)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:E
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:MME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2753 E. BROADWAY S-101 #394
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204
Mailing Address - Country:US
Mailing Address - Phone:602-369-8949
Mailing Address - Fax:
Practice Address - Street 1:2738 E BIRCHWOOD AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-1520
Practice Address - Country:US
Practice Address - Phone:602-369-8949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist