| Doctor Name: | MARY ELIZABETH UYTTEWAAL |
| NPI Number: | 1972838886 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS CCC/SLP |
| License Number: | SA9061 |
| Business Practice Address: | 1675 Dunlawton Ave Port Orange, FL - 321274755 |
| Business Phone Number: | 3867611055 |
| Business Fax Number: | 3863044119 |
| Mailing Address: | 2222 Sullivan Trl, EASTON |
| State: | PA |
| Postal Code: | 180407958 |
| Phone Number: | 8009449782 |
| Fax Number: | 6104382046 |
| NPI Enumeration Date: | 10/09/2009 |
| NPI Last Update Date: | 10/09/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | SA9061 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| 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 |