Provider Demographics
NPI:1255922464
Name:CURTIS, MARY PORTERA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:PORTERA
Last Name:CURTIS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 STRAWBERRY FIELD CV
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:TN
Mailing Address - Zip Code:38060-3496
Mailing Address - Country:US
Mailing Address - Phone:423-298-7544
Mailing Address - Fax:
Practice Address - Street 1:45 STRAWBERRY FIELD CV
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:TN
Practice Address - Zip Code:38060-3496
Practice Address - Country:US
Practice Address - Phone:423-298-7544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-30
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6963235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist