Provider Demographics
NPI:1851989578
Name:ALVARADO, MARY ANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:ALVARADO
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3626 SANTA CARLOTTA ST
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91214-1003
Mailing Address - Country:US
Mailing Address - Phone:818-726-4691
Mailing Address - Fax:
Practice Address - Street 1:3626 SANTA CARLOTTA ST
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91214-1003
Practice Address - Country:US
Practice Address - Phone:818-726-4691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10743235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist