Provider Demographics
NPI:1356708168
Name:PYRON, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:PYRON
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 1:818 OLD HARDY RD
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-8663
Mailing Address - Country:US
Mailing Address - Phone:662-299-9550
Mailing Address - Fax:
Practice Address - Street 1:627 MIDDLETON RD
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MS
Practice Address - Zip Code:38967-2021
Practice Address - Country:US
Practice Address - Phone:662-845-4399
Practice Address - Fax:662-845-4400
Is Sole Proprietor?:No
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3784235Z00000X
MS14070070235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist