Provider Demographics
NPI:1629464391
Name:BRYAN, MARY HARRELL (SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:HARRELL
Last Name:BRYAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 870242
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35487-0242
Mailing Address - Country:US
Mailing Address - Phone:205-348-7131
Mailing Address - Fax:205-348-1845
Practice Address - Street 1:700 UNIVERSITY BLVD E
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-2028
Practice Address - Country:US
Practice Address - Phone:205-348-7131
Practice Address - Fax:205-348-1845
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3733235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist