Doctor Name: | MS. TINA LEA MAYBERRY |
NPI Number: | 1669777447 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | SLP |
License Number: | 146005061 |
Business Practice Address: | 107 Sunset Dr Mc Leansboro, IL - 628591231 |
Business Phone Number: | 6186435005 |
Business Fax Number: | 6182417039 |
Mailing Address: | 107 Sunset Dr, MC LEANSBORO |
State: | IL |
Postal Code: | 628591231 |
Phone Number: | 6186435005 |
Fax Number: | 6182417039 |
NPI Enumeration Date: | 01/25/2011 |
NPI Last Update Date: | 01/25/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 146005061 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |