Provider Demographics
NPI:1912487745
Name:TEIXEIRA, MARY (SLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:TEIXEIRA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:CLIFFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4255 NORTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44128-2811
Mailing Address - Country:US
Mailing Address - Phone:216-292-9700
Mailing Address - Fax:216-378-4613
Practice Address - Street 1:24211 CENTER RIDGE RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-4211
Practice Address - Country:US
Practice Address - Phone:440-250-2520
Practice Address - Fax:440-250-2530
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND.2018634-SP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist