Provider Demographics
NPI:1497040604
Name:WINSLOW, MARY MICHELLE (MA)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:MICHELLE
Last Name:WINSLOW
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2124 W CHESTERFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-8650
Mailing Address - Country:US
Mailing Address - Phone:417-862-2273
Mailing Address - Fax:417-862-8659
Practice Address - Street 1:2124 W CHESTERFIELD BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-8650
Practice Address - Country:US
Practice Address - Phone:417-862-2273
Practice Address - Fax:417-862-8659
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor