Provider Demographics
NPI:1932610326
Name:SHORT, MARY ANN (MA, CCC-SP/L)
Entity Type:Individual
Prefix:MRS
First Name:MARY ANN
Middle Name:
Last Name:SHORT
Suffix:
Gender:F
Credentials:MA, CCC-SP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 WESTGLEN DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-1369
Mailing Address - Country:US
Mailing Address - Phone:630-428-6953
Mailing Address - Fax:
Practice Address - Street 1:1560 WESTGLEN DR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-1369
Practice Address - Country:US
Practice Address - Phone:630-428-6953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-12
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist