MEDICARE: MRS. MARY ALEXIA WELLS HOWARD SPEECH PATHOLOGIST M

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	13-029	KY

General Provider Information

NPI Number	:	1720498744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY ALEXIA WELLS HOWARD SPEECH PATHOLOGIST M

Provider Business Mailing Address
First Line	:	2139 S STRATFORD DR
Second Line	:
City	:	OWENSBORO
State	:	KY
Zip	:	42301-3429
Country	:	US
Telephone Number	:	270-625-4003
Fax Number	:	270-683-9993

Provider Business Practice Location Address
First Line	:	724 HARVARD DR
Second Line	:
City	:	OWENSBORO
State	:	KY
Zip	:	42301-6152
Country	:	US
Telephone Number	:	270-240-5051
Fax Number	:

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

Provider Enumeration Date	:	04/29/2014
Last Update Date	:	10/27/2021

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