MEDICARE: MARY ANDERSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP-2785	NV

General Provider Information

NPI Number	:	1437767365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ANDERSON

Provider Business Mailing Address
First Line	:	1135 BRADLEY BAY AVE
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89014-6705
Country	:	US
Telephone Number	:	702-233-8404
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 S CIMARRON RD STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-7902
Country	:	US
Telephone Number	:	702-462-5252
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2020
Last Update Date	:	07/16/2020

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Directions to “ MARY ANDERSON ” Practice Location

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