Provider Demographics
NPI:1952658361
Name:JEFFERIES, MARY ALLEN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ALLEN
Last Name:JEFFERIES
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:539 TANBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-3923
Mailing Address - Country:US
Mailing Address - Phone:910-350-6990
Mailing Address - Fax:
Practice Address - Street 1:3802 PRINCESS PLACE DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3226
Practice Address - Country:US
Practice Address - Phone:910-343-4245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3465235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist