Doctor Name: | MARY MIRACLE |
NPI Number: | 1669884813 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | BG1019507 |
Business Practice Address: | 300 Pike St Marietta, OH - 457503372 |
Business Phone Number: | 7403746514 |
Business Fax Number: | |
Mailing Address: | 903 5th St, MARIETTA |
State: | OH |
Postal Code: | 457501608 |
Phone Number: | 7404343635 |
Fax Number: | |
NPI Enumeration Date: | 05/22/2014 |
NPI Last Update Date: | 05/22/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | BG1019507 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | OH |
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 |