Provider Demographics
NPI:1770042574
Name:SCHILLING, MARY ELAINE (MS-CFY)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELAINE
Last Name:SCHILLING
Suffix:
Gender:F
Credentials:MS-CFY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 UPTOWN AVE APT 2055
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-4806
Mailing Address - Country:US
Mailing Address - Phone:315-264-5730
Mailing Address - Fax:
Practice Address - Street 1:8000 UPTOWN AVE APT 2055
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021-4806
Practice Address - Country:US
Practice Address - Phone:315-264-5730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000483235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist