Provider Demographics
NPI:1861660250
Name:BARR, MARYBETH (ST)
Entity Type:Individual
Prefix:
First Name:MARYBETH
Middle Name:
Last Name:BARR
Suffix:
Gender:F
Credentials:ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2819 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-0237
Mailing Address - Country:US
Mailing Address - Phone:877-316-1499
Mailing Address - Fax:812-649-2567
Practice Address - Street 1:2819 W 4TH ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-0237
Practice Address - Country:US
Practice Address - Phone:877-316-1499
Practice Address - Fax:812-649-2567
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22002459A235Z00000X
KYKY-1365235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist