Provider Demographics
NPI:1245642982
Name:TIPPETTE, MARY-ELIZABETH BYORICK (MSP, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MARY-ELIZABETH
Middle Name:BYORICK
Last Name:TIPPETTE
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Gender:F
Credentials:MSP, CCC-SLP
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Mailing Address - Street 1:3621 WICKERSHAM LN
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3583
Mailing Address - Country:US
Mailing Address - Phone:828-577-1094
Mailing Address - Fax:833-924-1004
Practice Address - Street 1:4045 UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3325
Practice Address - Country:US
Practice Address - Phone:828-577-1094
Practice Address - Fax:833-924-1004
Is Sole Proprietor?:No
Enumeration Date:2014-05-29
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA013275235Z00000X
NC9073235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist