Provider Demographics
NPI:1245519909
Name:RHODE, MARY (MS, CCC-LSLP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:RHODE
Suffix:
Gender:F
Credentials:MS, CCC-LSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLINVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14737-1038
Mailing Address - Country:US
Mailing Address - Phone:716-676-8000
Mailing Address - Fax:
Practice Address - Street 1:31 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANKLINVILLE
Practice Address - State:NY
Practice Address - Zip Code:14737-1038
Practice Address - Country:US
Practice Address - Phone:716-676-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013404-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist