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NPI Code Detail

MEDICARE: MRS. MARY LOUISE CRAIG M.ED, CCC-SLP

MEDICARE: MRS. MARY LOUISE CRAIG M.ED, 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 PathologistSA13863FL
2235Z00000XSpeech-Language Pathologist2202007333VA

General Provider Information

NPI Number : 1811321425
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARY LOUISE CRAIG M.ED, CCC-SLP
Provider Business Mailing Address
First Line : 10221 HUNTINGTON FOREST BLVD E
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32257-7688
Country : US
Telephone Number : 770-374-2234
Fax Number :
Provider Business Practice Location Address
First Line : 8495 NORMANDY BLVD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32221-6701
Country : US
Telephone Number : 904-783-3749
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2013
Last Update Date : 10/08/2015

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