Provider Demographics
NPI:1396917027
Name:RAINWATER, MARY ELAINE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ELAINE
Last Name:RAINWATER
Suffix:
Gender:F
Credentials:MS 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:PO BOX 741
Mailing Address - Street 2:
Mailing Address - City:CHECOTAH
Mailing Address - State:OK
Mailing Address - Zip Code:74426-0741
Mailing Address - Country:US
Mailing Address - Phone:918-521-6614
Mailing Address - Fax:
Practice Address - Street 1:23047 E 830 RD
Practice Address - Street 2:
Practice Address - City:WELLING
Practice Address - State:OK
Practice Address - Zip Code:74471-2144
Practice Address - Country:US
Practice Address - Phone:918-453-9896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3334235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist