Provider Demographics
NPI:1891207585
Name:SILBERNAGLE, MARY JOSEPHINE
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JOSEPHINE
Last Name:SILBERNAGLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 PINAL AVE
Mailing Address - Street 2:
Mailing Address - City:ORCUTT
Mailing Address - State:CA
Mailing Address - Zip Code:93455-5202
Mailing Address - Country:US
Mailing Address - Phone:808-780-2945
Mailing Address - Fax:702-564-5123
Practice Address - Street 1:410 PINAL AVE
Practice Address - Street 2:
Practice Address - City:ORCUTT
Practice Address - State:CA
Practice Address - Zip Code:93455-5202
Practice Address - Country:US
Practice Address - Phone:808-780-2945
Practice Address - Fax:702-564-5123
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP3828235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty