Provider Demographics
NPI:1811036528
Name:ZEHR, MARY L (MA, SLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:ZEHR
Suffix:
Gender:F
Credentials:MA, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:765-450-6664
Practice Address - Street 1:7311 EAGLE CREST BLVD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-8157
Practice Address - Country:US
Practice Address - Phone:812-213-8031
Practice Address - Fax:765-450-6664
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22001980A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
01084014OtherASHA BOARD CERTIFICATION
IN200725440AMedicaid