Provider Demographics
NPI:1720272131
Name:NUSSBAUM, MARY K (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:NUSSBAUM
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 1:385 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:WRIGHTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940
Mailing Address - Country:US
Mailing Address - Phone:215-598-1618
Mailing Address - Fax:
Practice Address - Street 1:385 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-3611
Practice Address - Country:US
Practice Address - Phone:215-598-1618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL005437L235Z00000X
NJ41YS00453900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist