Provider Demographics
NPI:1942394614
Name:MURRILL, MARY KEENAN (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KEENAN
Last Name:MURRILL
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17216 DEER RUN DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32820-2253
Mailing Address - Country:US
Mailing Address - Phone:321-689-4941
Mailing Address - Fax:
Practice Address - Street 1:17216 DEER RUN DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32820-2253
Practice Address - Country:US
Practice Address - Phone:321-689-4941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 5392235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist