Basic Information
| Provider Information | |||||||||
| NPI: | 1881851160 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COFFEY | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | B. | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA, CCC/SLP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CURTIN | ||||||||
| OtherFirstName: | MARY | ||||||||
| OtherMiddleName: | B. | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MA, CCC/SLP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 15 PEP PL | ||||||||
| Address2: | |||||||||
| City: | MILTON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054683567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8029993771 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 133 FAIRFIELD ST | ||||||||
| Address2: | |||||||||
| City: | SAINT ALBANS | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054781726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8025241064 | ||||||||
| FaxNumber: | 8025241025 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2008 | ||||||||
| LastUpdateDate: | 05/22/2008 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | VT | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 41YS00409500 | NJ | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.