Healthcare Provider Details

I. General information

NPI: 1013238195
Provider Name (Legal Business Name): MARY E. GROVER M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY CORRADI M.S. CCC-SLP

II. Dates (important events)

Enumeration Date: 06/12/2010
Last Update Date: 02/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 ORLEANS RD
NORTH CHATHAM MA
02650-1154
US

IV. Provider business mailing address

84 EARLES WAY
CHATHAM MA
02633-1703
US

V. Phone/Fax

Practice location:
  • Phone: 508-945-9611
  • Fax: 508-945-9603
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number8124
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: