Provider Demographics
NPI:1477273860
Name:STOKES, MARY KATHRYN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATHRYN
Last Name:STOKES
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4811 WESLEYAN WOODS DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-4116
Mailing Address - Country:US
Mailing Address - Phone:478-361-2194
Mailing Address - Fax:
Practice Address - Street 1:4811 WESLEYAN WOODS DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-4116
Practice Address - Country:US
Practice Address - Phone:478-361-2194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP009922235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist