Provider Demographics
NPI:1184339251
Name:HAUGHEY, MARY JO (SPEECH-LANGUAGE PATH)
Entity type:Individual
Prefix:MS
First Name:MARY JO
Middle Name:
Last Name:HAUGHEY
Suffix:
Gender:F
Credentials:SPEECH-LANGUAGE PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14997 RIVERS EDGE CT APT 155
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-7927
Mailing Address - Country:US
Mailing Address - Phone:239-357-2132
Mailing Address - Fax:
Practice Address - Street 1:14997 RIVERS EDGE CT APT 155
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-7927
Practice Address - Country:US
Practice Address - Phone:239-357-2132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6812235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist