Basic Information
| Provider Information | |||||||||
| NPI: | 1598980419 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAWSON | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | EVELYN | ||||||||
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| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4500 BISSONNET ST | ||||||||
| Address2: | SUITE 340 | ||||||||
| City: | BELLAIRE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774013120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7138389050 | ||||||||
| FaxNumber: | 7138380926 | ||||||||
| Practice Location | |||||||||
| Address1: | 4500 BISSONNET ST | ||||||||
| Address2: | SUITE 340 | ||||||||
| City: | BELLAIRE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774013120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7138389050 | ||||||||
| FaxNumber: | 7138380926 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2007 | ||||||||
| LastUpdateDate: | 02/11/2013 | ||||||||
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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 | 15984 | TX | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 0040339-01 | 05 | TX | MEDICAID | 8T2737 | 01 | TX | BCBS | OTHER |