MEDICARE: MRS. MARY KEY 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
1	235Z00000X	Speech-Language Pathologist	1465	KY

General Provider Information

NPI Number	:	1346327012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY KEY MA, CCC/SLP

Provider Business Mailing Address
First Line	:	576 WHITE MILLS GLENDALE RD E
Second Line	:
City	:	GLENDALE
State	:	KY
Zip	:	42740-7702
Country	:	US
Telephone Number	:	270-369-8499
Fax Number	:

Provider Business Practice Location Address
First Line	:	576 WHITE MILLS GLENDALE RD E
Second Line	:
City	:	GLENDALE
State	:	KY
Zip	:	42740-7702
Country	:	US
Telephone Number	:	270-369-8499
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/08/2007

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