Provider Demographics
NPI:1063831253
Name:GRECO, MARY ELIZABETH (CCC/SLP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:GRECO
Suffix:
Gender:
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 GONZALES DR
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMOS
Mailing Address - State:CA
Mailing Address - Zip Code:93440-5012
Mailing Address - Country:US
Mailing Address - Phone:805-895-3123
Mailing Address - Fax:
Practice Address - Street 1:1414 S MILLER ST STE 10G
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-6916
Practice Address - Country:US
Practice Address - Phone:805-750-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13372235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist