Provider Demographics
NPI:1851949374
Name:MAYFIELD, MARGARET (PEG) ANN (SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARGARET (PEG)
Middle Name:ANN
Last Name:MAYFIELD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6318 A HWY
Mailing Address - Street 2:
Mailing Address - City:BUNCETON
Mailing Address - State:MO
Mailing Address - Zip Code:65237-2204
Mailing Address - Country:US
Mailing Address - Phone:660-620-2750
Mailing Address - Fax:
Practice Address - Street 1:500 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:BUNCETON
Practice Address - State:MO
Practice Address - Zip Code:65237
Practice Address - Country:US
Practice Address - Phone:660-427-5415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO235Z00000XOtherSCHOOL FOR SPEECH/LANGUAGE THERAPY