Provider Demographics
NPI:1780851295
Name:POPE, MARY A (AUD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:POPE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:A
Other - Last Name:LIVINGOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:317-962-4792
Mailing Address - Fax:317-962-8646
Practice Address - Street 1:702 BARNHILL DR
Practice Address - Street 2:SUITE 0860
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5128
Practice Address - Country:US
Practice Address - Phone:317-274-8868
Practice Address - Fax:317-274-6680
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23000596231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200646680Medicaid