Provider Demographics
NPI:1710473657
Name:XIONG, MARY (SLP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:XIONG
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3291 S THOMPSON ST STE C103
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-7343
Mailing Address - Country:US
Mailing Address - Phone:479-750-3535
Mailing Address - Fax:479-750-3539
Practice Address - Street 1:3291 S THOMPSON ST STE C103
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-7343
Practice Address - Country:US
Practice Address - Phone:479-750-3535
Practice Address - Fax:479-750-3539
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR200089235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist