Provider Demographics
NPI:1336849108
Name:HAY, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:HAY
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 1:1220 E JACKSON BLVD
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46516-4419
Mailing Address - Country:US
Mailing Address - Phone:574-333-9747
Mailing Address - Fax:574-367-2369
Practice Address - Street 1:1220 E JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516-4419
Practice Address - Country:US
Practice Address - Phone:574-333-9747
Practice Address - Fax:574-367-2369
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22001715A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist