Provider Demographics
NPI:1740476274
Name:MABE, MARIA ROSE (MSCCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:ROSE
Last Name:MABE
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:MISS
Other - First Name:MARIA
Other - Middle Name:ROSE
Other - Last Name:CHEANEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSCCC-SLP
Mailing Address - Street 1:75 S COUNTY ROAD 400 E
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-9410
Mailing Address - Country:US
Mailing Address - Phone:317-504-8108
Mailing Address - Fax:
Practice Address - Street 1:75 S COUNTY ROAD 400 E
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-9410
Practice Address - Country:US
Practice Address - Phone:317-504-8108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22002201A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist