Provider Demographics
NPI:1629201983
Name:AUGUSTINE, MARY M (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:M
Last Name:AUGUSTINE
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 1:413 STONEBRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-3012
Mailing Address - Country:US
Mailing Address - Phone:214-991-2059
Mailing Address - Fax:
Practice Address - Street 1:580 S DENTON TAP RD STE 270
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4094
Practice Address - Country:US
Practice Address - Phone:469-763-9459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103453235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist