Provider Demographics
NPI:1245692045
Name:BARTA, MARY GRACE (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:GRACE
Last Name:BARTA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:889 MORNING GLORY DR
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97351-9580
Mailing Address - Country:US
Mailing Address - Phone:971-208-3113
Mailing Address - Fax:971-456-0092
Practice Address - Street 1:889 MORNING GLORY DR
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OR
Practice Address - Zip Code:97351-9580
Practice Address - Country:US
Practice Address - Phone:971-208-3113
Practice Address - Fax:971-456-0092
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR016443235Z00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist