Provider Demographics
NPI:1821643644
Name:BRIGGS, MARY GRACE
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:GRACE
Last Name:BRIGGS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:GRACE
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 W CALHOUN
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:AR
Mailing Address - Zip Code:71753-3508
Mailing Address - Country:US
Mailing Address - Phone:870-901-3343
Mailing Address - Fax:
Practice Address - Street 1:409 E 10TH ST
Practice Address - Street 2:
Practice Address - City:SMACKOVER
Practice Address - State:AR
Practice Address - Zip Code:71762-2143
Practice Address - Country:US
Practice Address - Phone:870-918-2227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR202878235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist