Provider Demographics
NPI:1689864480
Name:PARKER, MARY KAY (MS)
Entity Type:Individual
Prefix:MISS
First Name:MARY
Middle Name:KAY
Last Name:PARKER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19495 N 90TH LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-8560
Mailing Address - Country:US
Mailing Address - Phone:623-362-9187
Mailing Address - Fax:
Practice Address - Street 1:19495 N 90TH LN
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-8560
Practice Address - Country:US
Practice Address - Phone:623-362-9187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPL 5463235Z00000X
AZSLPL5463235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist