Provider Demographics
NPI:1982039780
Name:NEWCOM, MARY ANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MARY ANN
Middle Name:
Last Name:NEWCOM
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 1:364 S. PARK STREET
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-3293
Mailing Address - Country:US
Mailing Address - Phone:509-526-1779
Mailing Address - Fax:509-526-4344
Practice Address - Street 1:364 S. PARK STREET
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-3293
Practice Address - Country:US
Practice Address - Phone:509-526-1779
Practice Address - Fax:509-526-4344
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LL60015392235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALL60015392OtherWASHINGTON STATE DEPARTMENT OF HEALTH