Provider Demographics
NPI:1831889393
Name:LUPLOW, MARY (CCLS)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:LUPLOW
Suffix:
Gender:F
Credentials:CCLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 S WARREN ST APT 9
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-1996
Mailing Address - Country:US
Mailing Address - Phone:810-434-1432
Mailing Address - Fax:
Practice Address - Street 1:365 S WARREN ST APT 9
Practice Address - Street 2:
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-1996
Practice Address - Country:US
Practice Address - Phone:810-434-1432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist