Provider Demographics
NPI:1881851160
Name:COFFEY, MARY B (MA, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:B
Last Name:COFFEY
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:B
Other - Last Name:CURTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC/SLP
Mailing Address - Street 1:15 PEP PL
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:VT
Mailing Address - Zip Code:05468-3567
Mailing Address - Country:US
Mailing Address - Phone:802-999-3771
Mailing Address - Fax:
Practice Address - Street 1:133 FAIRFIELD ST
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-1726
Practice Address - Country:US
Practice Address - Phone:802-524-1064
Practice Address - Fax:802-524-1025
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT235Z00000X
NJ41YS00409500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist