Provider Demographics
NPI:1669511283
Name:STEELE, MARY L (MA-CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:L
Last Name:STEELE
Suffix:
Gender:F
Credentials:MA-CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 WATERFORD ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-9384
Mailing Address - Country:US
Mailing Address - Phone:386-426-2992
Mailing Address - Fax:
Practice Address - Street 1:2305 S RIDGEWOOD AVE
Practice Address - Street 2:SUITE A
Practice Address - City:EDGEWATER
Practice Address - State:FL
Practice Address - Zip Code:32141-4227
Practice Address - Country:US
Practice Address - Phone:386-428-4805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1622235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist