Healthcare Provider Details

I. General information

NPI: 1609909936
Provider Name (Legal Business Name): MANDI LYNN HEMRY MA CCC SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 02/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SCHOOL DIST R 7 TRI COUNTY 904 W AUBERRY GRV
JAMESPORT MO
64648-7374
US

IV. Provider business mailing address

904 W AUBERRY GRV
JAMESPORT MO
64648-7374
US

V. Phone/Fax

Practice location:
  • Phone: 660-684-6118
  • Fax: 660-684-6218
Mailing address:
  • Phone: 660-684-6118
  • Fax: 660-684-6218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2002020207
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: