Provider Demographics
NPI:1255527990
Name:NEAL, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:NEAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:MO
Mailing Address - Zip Code:65753-0160
Mailing Address - Country:US
Mailing Address - Phone:417-634-3223
Mailing Address - Fax:417-634-3156
Practice Address - Street 1:217 DIVISION ST
Practice Address - Street 2:SPARTA R III
Practice Address - City:SPARTA
Practice Address - State:MO
Practice Address - Zip Code:65753-0160
Practice Address - Country:US
Practice Address - Phone:417-634-3223
Practice Address - Fax:417-634-3156
Is Sole Proprietor?:No
Enumeration Date:2007-09-17
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006024367235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist