Basic Information
| Provider Information | |||||||||
| NPI: | 1306948427 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOWE | ||||||||
| FirstName: | MARY ANN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3301 COLLEGE AVE | ||||||||
| Address2: | GRIFFIN ROAD CLINIC | ||||||||
| City: | DAVIE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333147721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9542627708 | ||||||||
| FaxNumber: | 9542622847 | ||||||||
| Practice Location | |||||||||
| Address1: | 3301 COLLEGE AVE | ||||||||
| Address2: | GRIFFIN ROAD CLINIC | ||||||||
| City: | DAVIE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333147721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9542627708 | ||||||||
| FaxNumber: | 9542622847 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SA1528 | FL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 01085161 | 01 | FL | ASHA, CCC-SLP | OTHER | SA1528 | 01 | FL | STATE OF FL DEPT OF HEALT | OTHER |