Provider Demographics
NPI:1669904397
Name:DOIRON, MARY (SLP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:DOIRON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:O'DELL-DOIRON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1375 CHANEY AVE
Mailing Address - Street 2:
Mailing Address - City:CARPINTERIA
Mailing Address - State:CA
Mailing Address - Zip Code:93013-1720
Mailing Address - Country:US
Mailing Address - Phone:805-450-2794
Mailing Address - Fax:
Practice Address - Street 1:1375 CHANEY AVE
Practice Address - Street 2:
Practice Address - City:CARPINTERIA
Practice Address - State:CA
Practice Address - Zip Code:93013-1720
Practice Address - Country:US
Practice Address - Phone:805-450-2794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP5632235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASP 5632OtherDEPARTMENT OF CONSUMER AFFAIRS
00879833OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOCIAITON