Healthcare Provider Details

I. General information

NPI: 1598973802
Provider Name (Legal Business Name): MARY ANN BYERLY CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1358 S VAL VISTA RD
APACHE JUNCTION AZ
85219-7818
US

IV. Provider business mailing address

1358 S VAL VISTA RD
APACHE JUNCTION AZ
85219-7818
US

V. Phone/Fax

Practice location:
  • Phone: 480-983-9842
  • Fax: 480-983-3271
Mailing address:
  • Phone: 480-983-9842
  • Fax: 480-983-3271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP0422
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: