Provider Demographics
NPI:1841508280
Name:LAFORGE, MARY KATHRYN (MSP, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KATHRYN
Last Name:LAFORGE
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 DECKER DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-9469
Mailing Address - Country:US
Mailing Address - Phone:864-980-0786
Mailing Address - Fax:
Practice Address - Street 1:301 PINEHAVEN STREET EXT
Practice Address - Street 2:
Practice Address - City:LAURENS
Practice Address - State:SC
Practice Address - Zip Code:29360-2671
Practice Address - Country:US
Practice Address - Phone:864-984-6584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4739235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist