Provider Demographics
NPI:1568754703
Name:KLIMEK, MARY MCDONALD (MS, CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:MCDONALD
Last Name:KLIMEK
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 1:30 MUNROE RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-7812
Mailing Address - Country:US
Mailing Address - Phone:781-862-8143
Mailing Address - Fax:
Practice Address - Street 1:30 MUNROE RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-7812
Practice Address - Country:US
Practice Address - Phone:781-862-8143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-06
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4138235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist