Provider Demographics
NPI:1780933036
Name:DELAO, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:DELAO
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 1:108 PAINT TRAIL
Mailing Address - Street 2:
Mailing Address - City:ELEPHANT BUTTE
Mailing Address - State:NM
Mailing Address - Zip Code:87935
Mailing Address - Country:US
Mailing Address - Phone:575-267-8290
Mailing Address - Fax:
Practice Address - Street 1:108 PAINT TRAIL
Practice Address - Street 2:
Practice Address - City:ELEPHANT BUTTE
Practice Address - State:NM
Practice Address - Zip Code:87935
Practice Address - Country:US
Practice Address - Phone:575-267-8290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM51842355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant