Provider Demographics
NPI:1851507081
Name:BEER, MARY M (SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:M
Last Name:BEER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3917 DALEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-5942
Mailing Address - Country:US
Mailing Address - Phone:260-422-8520
Mailing Address - Fax:260-422-9345
Practice Address - Street 1:1649 SPY RUN AVE
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4032
Practice Address - Country:US
Practice Address - Phone:260-422-8520
Practice Address - Fax:260-422-9345
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003176A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist