Provider Demographics
NPI:1689115768
Name:HAYASHI, MARI MIYAMOTO (PHD/CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARI
Middle Name:MIYAMOTO
Last Name:HAYASHI
Suffix:
Gender:F
Credentials:PHD/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8409 N RUN MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-2309
Mailing Address - Country:US
Mailing Address - Phone:804-569-6240
Mailing Address - Fax:804-569-6244
Practice Address - Street 1:8409 N RUN MEDICAL DR
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2309
Practice Address - Country:US
Practice Address - Phone:804-569-6240
Practice Address - Fax:804-569-6244
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101048206207YX0905X
VA2202001577235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist