Provider Demographics
NPI:1508148818
Name:PRENTICE, MARIA M (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:M
Last Name:PRENTICE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-1604
Mailing Address - Country:US
Mailing Address - Phone:716-677-3620
Mailing Address - Fax:
Practice Address - Street 1:4100 CLINTON ST
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-1604
Practice Address - Country:US
Practice Address - Phone:716-677-3620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010255235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist