Provider Demographics
NPI:1245501824
Name:WEBB, MARY LYNNE (MCD CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LYNNE
Last Name:WEBB
Suffix:
Gender:F
Credentials:MCD CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:642 HIGHWAY 258
Mailing Address - Street 2:
Mailing Address - City:BALD KNOB
Mailing Address - State:AR
Mailing Address - Zip Code:72010-9720
Mailing Address - Country:US
Mailing Address - Phone:501-203-5200
Mailing Address - Fax:
Practice Address - Street 1:1201 W CENTER ST
Practice Address - Street 2:
Practice Address - City:BEEBE
Practice Address - State:AR
Practice Address - Zip Code:72012-3103
Practice Address - Country:US
Practice Address - Phone:501-882-5463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1014235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR189562795Medicaid