Provider Demographics
NPI:1881881365
Name:JOHN, MAE Y (MS CF SLP)
Entity type:Individual
Prefix:MRS
First Name:MAE
Middle Name:Y
Last Name:JOHN
Suffix:
Gender:F
Credentials:MS CF SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 559
Mailing Address - Street 2:WRUSD NO 8 SPECIAL EDUCATION DEPARTMENT
Mailing Address - City:FORT DEFIANCE
Mailing Address - State:AZ
Mailing Address - Zip Code:86504
Mailing Address - Country:US
Mailing Address - Phone:928-729-6755
Mailing Address - Fax:928-729-7630
Practice Address - Street 1:NAVAJO ROUTE 12
Practice Address - Street 2:WINDOW ROCK UNIFIED SCHOOL DISTRICT #8
Practice Address - City:FT DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:86504
Practice Address - Country:US
Practice Address - Phone:928-729-6754
Practice Address - Fax:928-729-7630
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZSLPL4682OtherDEPT OF HEALTH SERVICES
AZSLPL4682OtherDEPT OF HEALTH SERVICES