Provider Demographics
NPI:1740758242
Name:GARCIA, MARY MAHALARES (SLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MAHALARES
Last Name:GARCIA
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 1:4707 140TH AVE N STE 313
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762-3841
Mailing Address - Country:US
Mailing Address - Phone:727-223-8978
Mailing Address - Fax:727-303-3952
Practice Address - Street 1:4707 140TH AVE N STE 313
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33762-3841
Practice Address - Country:US
Practice Address - Phone:727-223-8978
Practice Address - Fax:727-303-3952
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA4052235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSA4052OtherSTATE LICENSE