Provider Demographics
NPI:1134574759
Name:CAMPOSANO, MARY ELLEN (MS, CCC-SLP, CAED)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ELLEN
Last Name:CAMPOSANO
Suffix:
Gender:F
Credentials:MS, CCC-SLP, CAED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10017 CHEZELLE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-5409
Mailing Address - Country:US
Mailing Address - Phone:915-309-6576
Mailing Address - Fax:
Practice Address - Street 1:1101 N CAMPBELL ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4238
Practice Address - Country:US
Practice Address - Phone:915-747-8220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12089349235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist