Provider Demographics
NPI:1932744125
Name:MAHER, MARY BETH (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:BETH
Last Name:MAHER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10007 S SAINT LOUIS AVE
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-3412
Mailing Address - Country:US
Mailing Address - Phone:773-706-0960
Mailing Address - Fax:
Practice Address - Street 1:165 INDIANA ST
Practice Address - Street 2:
Practice Address - City:PARK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60466-1078
Practice Address - Country:US
Practice Address - Phone:708-747-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-11
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146009518235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist