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NPI Code Detail

MEDICARE: MARY EAST MS, CCC-SLP

MEDICARE: MARY EAST MS, CCC-SLP
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
1235Z00000XSpeech-Language PathologistS4070MS

General Provider Information

NPI Number : 1609468107
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY EAST MS, CCC-SLP
Provider Business Mailing Address
First Line : 2807 BELMONT DR
Second Line :
City : OCEAN SPRINGS
State : MS
Zip : 39564-5648
Country : US
Telephone Number : 901-833-2519
Fax Number :
Provider Business Practice Location Address
First Line : 6017 WASHINGTON AVE
Second Line :
City : OCEAN SPRINGS
State : MS
Zip : 39564-2648
Country : US
Telephone Number : 228-334-5035
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2021
Last Update Date : 02/05/2021

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Directions to “ MARY EAST MS, CCC-SLP” Practice Location

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