Provider Demographics
NPI:1558665232
Name:FRIDAY, MARY-BETH (MED CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARY-BETH
Middle Name:
Last Name:FRIDAY
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 GLENHAVEN LN
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-1128
Mailing Address - Country:US
Mailing Address - Phone:920-737-2152
Mailing Address - Fax:
Practice Address - Street 1:566 REDBIRD CIR
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-8796
Practice Address - Country:US
Practice Address - Phone:920-737-2152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-10
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2599-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist