Provider Demographics
NPI:1760689723
Name:LOWERY, MARY ANGELA (MED, CCCSLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANGELA
Last Name:LOWERY
Suffix:
Gender:F
Credentials:MED, CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4222 HERMITAGE HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-4636
Mailing Address - Country:US
Mailing Address - Phone:512-585-1093
Mailing Address - Fax:
Practice Address - Street 1:4222 HERMITAGE HOLLOW LN
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-4636
Practice Address - Country:US
Practice Address - Phone:512-585-1093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17002235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist