Provider Demographics
NPI:1790528503
Name:BRITTAIN, MARY (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:BRITTAIN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:LIZA
Other - Middle Name:
Other - Last Name:BRITTAIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:124 HUMMINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:STATHAM
Mailing Address - State:GA
Mailing Address - Zip Code:30666-2480
Mailing Address - Country:US
Mailing Address - Phone:478-361-7979
Mailing Address - Fax:
Practice Address - Street 1:196 BEN BURTON CIR
Practice Address - Street 2:
Practice Address - City:BOGART
Practice Address - State:GA
Practice Address - Zip Code:30622-1790
Practice Address - Country:US
Practice Address - Phone:678-205-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SLP013071235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist