Provider Demographics
NPI:1437309689
Name:HALLETT, MARY JO (MS, ED)
Entity Type:Individual
Prefix:MS
First Name:MARY JO
Middle Name:
Last Name:HALLETT
Suffix:
Gender:F
Credentials:MS, ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 CHARLESGATE CIR
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-1217
Mailing Address - Country:US
Mailing Address - Phone:716-636-8782
Mailing Address - Fax:
Practice Address - Street 1:700 SWEET HOME RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1444
Practice Address - Country:US
Practice Address - Phone:716-836-7556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
203334081252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency