Provider Demographics
NPI:1457703829
Name:NEUHARTH, MARY THERESA ANNE
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:THERESA ANNE
Last Name:NEUHARTH
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:THERESA ANNE
Other - Last Name:JODZIEWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5202 OLYMPIC DR NW
Mailing Address - Street 2:STE 100
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1727
Mailing Address - Country:US
Mailing Address - Phone:253-851-0007
Mailing Address - Fax:
Practice Address - Street 1:5202 OLYMPIC DR NW
Practice Address - Street 2:SUITE #100
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1727
Practice Address - Country:US
Practice Address - Phone:253-851-0007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-08
Last Update Date:2016-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASI 60667828235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist