Provider Demographics
NPI:1649335605
Name:STONE, MARYALICE M (MS, CCC-SLP,AET)
Entity type:Individual
Prefix:MS
First Name:MARYALICE
Middle Name:M
Last Name:STONE
Suffix:
Gender:F
Credentials:MS, CCC-SLP,AET
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 BASSETTS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD CENTER
Mailing Address - State:CT
Mailing Address - Zip Code:06250-1328
Mailing Address - Country:US
Mailing Address - Phone:860-455-1334
Mailing Address - Fax:860-455-0225
Practice Address - Street 1:344 BASSETTS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD CENTER
Practice Address - State:CT
Practice Address - Zip Code:06250-1328
Practice Address - Country:US
Practice Address - Phone:860-455-1334
Practice Address - Fax:860-455-0225
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000896235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2834945Medicare UPIN
CT004051611-00Medicare UPIN
CT660000896CT01Medicare UPIN
CT7296341Medicare UPIN
CT3297229Medicare UPIN
CT2261924Medicare UPIN
CT803200M3733100Medicare UPIN