Provider Demographics
NPI:1922014935
Name:BARRY, MARY C (SLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:BARRY
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 1:15 SPINNING WHEEL RD
Mailing Address - Street 2:SUITE 117
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-2914
Mailing Address - Country:US
Mailing Address - Phone:630-654-8888
Mailing Address - Fax:
Practice Address - Street 1:15 SPINNING WHEEL RD
Practice Address - Street 2:SUITE 117
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-2914
Practice Address - Country:US
Practice Address - Phone:630-654-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2219794OtherBCBS PROVIDER NUMBER