Provider Demographics
NPI:1780968248
Name:CALCATERRA, MARY JO (MA CCC SLP)
Entity type:Individual
Prefix:
First Name:MARY JO
Middle Name:
Last Name:CALCATERRA
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14145 SIMONE DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-3228
Mailing Address - Country:US
Mailing Address - Phone:586-566-6280
Mailing Address - Fax:586-566-1898
Practice Address - Street 1:14145 SIMONE DR
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48315-3228
Practice Address - Country:US
Practice Address - Phone:586-566-6280
Practice Address - Fax:586-566-1898
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI01119042235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist