Provider Demographics
NPI:1942608864
Name:DECARLO, MARY BARBARA (MA,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BARBARA
Last Name:DECARLO
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 1:1663 25TH ST
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-1011
Mailing Address - Country:US
Mailing Address - Phone:330-338-7296
Mailing Address - Fax:
Practice Address - Street 1:1663 25TH ST
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-1011
Practice Address - Country:US
Practice Address - Phone:330-338-7296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7106235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist