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NPI Code Detail

MEDICARE: MS. MARY E SHAW MA,CCC-SLP

MEDICARE: MS. MARY E SHAW MA,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 Pathologist12334CA

General Provider Information

NPI Number : 1821226374
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARY E SHAW MA,CCC-SLP
Provider Business Mailing Address
First Line : 3205 HURLEY WAY
Second Line :
City : SACRAMENTO
State : CA
Zip : 95864-3853
Country : US
Telephone Number : 916-485-6711
Fax Number : 916-485-2653
Provider Business Practice Location Address
First Line : 3205 HURLEY WAY
Second Line :
City : SACRAMENTO
State : CA
Zip : 95864-3853
Country : US
Telephone Number : 916-485-6711
Fax Number : 916-485-2653
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2009
Last Update Date : 06/23/2009

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