Provider Demographics
NPI:1689739252
Name:BARKER, MARY A (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:A
Last Name:BARKER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 HAVERHILL ST
Mailing Address - Street 2:
Mailing Address - City:ROWLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01969-2113
Mailing Address - Country:US
Mailing Address - Phone:978-857-7487
Mailing Address - Fax:
Practice Address - Street 1:100 CUMMINGS CTR
Practice Address - Street 2:SUITE 135H
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6115
Practice Address - Country:US
Practice Address - Phone:978-927-0172
Practice Address - Fax:978-927-0179
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA197877235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist