Provider Demographics
NPI:1780299552
Name:ATCHISON, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:ATCHISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:798 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63967-8123
Mailing Address - Country:US
Mailing Address - Phone:573-208-9324
Mailing Address - Fax:
Practice Address - Street 1:127 WALNUT STREET
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MO
Practice Address - Zip Code:63944
Practice Address - Country:US
Practice Address - Phone:573-224-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist