Provider Demographics
NPI:1578717344
Name:GERRAUGHTY, MARY ELLEN CARRIGAN (M ED CCC/SP)
Entity Type:Individual
Prefix:MRS
First Name:MARY ELLEN
Middle Name:CARRIGAN
Last Name:GERRAUGHTY
Suffix:
Gender:F
Credentials:M ED CCC/SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 SYLVAN DR
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648-2718
Mailing Address - Country:US
Mailing Address - Phone:814-696-0329
Mailing Address - Fax:
Practice Address - Street 1:23 SYLVAN DR
Practice Address - Street 2:
Practice Address - City:HOLLIDAYSBURG
Practice Address - State:PA
Practice Address - Zip Code:16648-2718
Practice Address - Country:US
Practice Address - Phone:814-696-0329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL002398L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist