Provider Demographics
NPI:1851727044
Name:MAYR, MARY K (HIS)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:K
Last Name:MAYR
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506A E. LONGIVEW DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-2105
Mailing Address - Country:US
Mailing Address - Phone:920-731-6477
Mailing Address - Fax:
Practice Address - Street 1:506A E. LONGIVEW DRIVE
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-2105
Practice Address - Country:US
Practice Address - Phone:920-731-6477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI849-60237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist