Healthcare Provider Details

I. General information

NPI: 1922302405
Provider Name (Legal Business Name): MARY ELLEN POPE M.S., CCC/SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2010
Last Update Date: 12/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 OLD LYMAN RD
SOUTH HADLEY MA
01075-2630
US

IV. Provider business mailing address

30 OLD LYMAN RD
SOUTH HADLEY MA
01075-2630
US

V. Phone/Fax

Practice location:
  • Phone: 413-533-7140
  • Fax:
Mailing address:
  • Phone: 413-533-7140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2742
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: