MEDICARE: MARY MARGARET MCDADE MS SPEECH PATHOLOGY

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	3100	NC

General Provider Information

NPI Number	:	1831919836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY MARGARET MCDADE MS SPEECH PATHOLOGY

Provider Business Mailing Address
First Line	:	208 ORLANDO WAY APT B
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-4588
Country	:	US
Telephone Number	:	252-714-4366
Fax Number	:

Provider Business Practice Location Address
First Line	:	208 ORLANDO WAY APT B
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-4588
Country	:	US
Telephone Number	:	252-714-4366
Fax Number	:

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

Provider Enumeration Date	:	10/14/2024
Last Update Date	:	10/14/2024

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