Provider Demographics
NPI:1750630448
Name:MULLANEY, MARY BETH K (MS CCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:MARY BETH
Middle Name:K
Last Name:MULLANEY
Suffix:
Gender:F
Credentials:MS CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 STAFFORD RD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29626-5674
Mailing Address - Country:US
Mailing Address - Phone:813-956-3614
Mailing Address - Fax:
Practice Address - Street 1:22 STAFFORD RD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29626-5674
Practice Address - Country:US
Practice Address - Phone:813-956-3614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4992235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist