Provider Demographics
NPI:1942421482
Name:BOIA, MARY CARPENTER (MACCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CARPENTER
Last Name:BOIA
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:CARPENTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MACCC-SLP
Mailing Address - Street 1:5125 BURRELL DRIVE
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44054
Mailing Address - Country:US
Mailing Address - Phone:440-934-9968
Mailing Address - Fax:
Practice Address - Street 1:5125 BURRELL DRIVE
Practice Address - Street 2:
Practice Address - City:SHEFFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44054
Practice Address - Country:US
Practice Address - Phone:440-934-9968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP3288235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist