Provider Demographics
NPI:1679794887
Name:ALBERG, MARY THERESE (MS, CCC, SLP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:THERESE
Last Name:ALBERG
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 1:1225 1ST ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-1206
Mailing Address - Country:US
Mailing Address - Phone:715-386-9970
Mailing Address - Fax:
Practice Address - Street 1:1225 1ST ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-1206
Practice Address - Country:US
Practice Address - Phone:715-386-9970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1546-154235Z00000X
MN5171235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist