Provider Demographics
NPI:1730636754
Name:GARAVAGLIA, MARY (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:GARAVAGLIA
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 NEW BERN RIDGE DR APT 206
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1286
Mailing Address - Country:US
Mailing Address - Phone:512-679-5621
Mailing Address - Fax:
Practice Address - Street 1:3301 NEW BERN RIDGE DR APT 206
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1286
Practice Address - Country:US
Practice Address - Phone:512-679-5621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-07
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12360235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12136977OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION
NC12360OtherNORTH CAROLINA BOARD OF EXAMINERS FOR SPEECH LANGUAGE PATHOLOGY AND AUDIOLOGY