MEDICARE: MARY ANN RECORDS PH.D.

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	107007	MO
2	235Z00000X	Speech-Language Pathologist	SP-1457	NV

General Provider Information

NPI Number	:	1386906287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ANN RECORDS PH.D.

Provider Business Mailing Address
First Line	:	7621 WINGSPREAD ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-3761
Country	:	US
Telephone Number	:	816-914-2752
Fax Number	:

Provider Business Practice Location Address
First Line	:	7621 WINGSPREAD ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-3761
Country	:	US
Telephone Number	:	816-914-2752
Fax Number	:

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

Provider Enumeration Date	:	06/15/2012
Last Update Date	:	11/12/2012

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Directions to “ MARY ANN RECORDS PH.D.” Practice Location

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