Provider Demographics
NPI:1245525575
Name:PATE, MARY ELIZABETH (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ELIZABETH
Last Name:PATE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ELIZABETH
Other - Last Name:MCAFEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CF-SLP
Mailing Address - Street 1:5853 ARCH AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32526-3231
Mailing Address - Country:US
Mailing Address - Phone:850-324-2259
Mailing Address - Fax:
Practice Address - Street 1:5853 ARCH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32526-3231
Practice Address - Country:US
Practice Address - Phone:850-324-2259
Practice Address - Fax:850-807-5310
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ5444235Z00000X
FLSA17790235Z00000X
NC10121235Z00000X
FLSA11702235Z00000X
GASLP008112235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106286000Medicaid