Provider Demographics
NPI:1013293646
Name:BLEAU, MARY M (MA, SLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:BLEAU
Suffix:
Gender:F
Credentials:MA, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:MOOERS
Mailing Address - State:NY
Mailing Address - Zip Code:12958-4223
Mailing Address - Country:US
Mailing Address - Phone:518-236-7373
Mailing Address - Fax:
Practice Address - Street 1:16 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:MOOERS
Practice Address - State:NY
Practice Address - Zip Code:12958-4223
Practice Address - Country:US
Practice Address - Phone:518-236-7373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018791-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist