Provider Demographics
NPI:1730499658
Name:SIMPSON, MARY ANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ANN
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1912 MEMORIAL AVE
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501
Mailing Address - Country:US
Mailing Address - Phone:434-845-8765
Mailing Address - Fax:434-845-5467
Practice Address - Street 1:1912 MEMORIAL AVE
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501
Practice Address - Country:US
Practice Address - Phone:434-845-8765
Practice Address - Fax:434-845-5467
Is Sole Proprietor?:No
Enumeration Date:2010-10-13
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA496612OtherMEDICARE
VA1396706065Medicaid
VA1720111404OtherANTHEM