Provider Demographics
NPI:1376366914
Name:HOMER, MARY KATHRYN (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATHRYN
Last Name:HOMER
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7320 N PALMYRA RD
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9709
Mailing Address - Country:US
Mailing Address - Phone:330-533-8755
Mailing Address - Fax:
Practice Address - Street 1:47 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-2099
Practice Address - Country:US
Practice Address - Phone:330-757-7003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.09725235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist