Provider Demographics
NPI:1861651499
Name:HERRERO, MARY ANN L (SLP)
Entity Type:Individual
Prefix:MS
First Name:MARY ANN
Middle Name:L
Last Name:HERRERO
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 1:1423 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:KULPMONT
Mailing Address - State:PA
Mailing Address - Zip Code:17834-1010
Mailing Address - Country:US
Mailing Address - Phone:570-373-3980
Mailing Address - Fax:
Practice Address - Street 1:1423 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:KULPMONT
Practice Address - State:PA
Practice Address - Zip Code:17834-1010
Practice Address - Country:US
Practice Address - Phone:570-373-3980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL003028L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist