Provider Demographics
NPI:1093521494
Name:SLOAN, MARY R (HIS)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:R
Last Name:SLOAN
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 5TH ST NE STE 101
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-4471
Mailing Address - Country:US
Mailing Address - Phone:763-682-6969
Mailing Address - Fax:763-317-6723
Practice Address - Street 1:151 5TH ST NE STE 101
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-4471
Practice Address - Country:US
Practice Address - Phone:763-682-6969
Practice Address - Fax:763-317-6723
Is Sole Proprietor?:No
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2951237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist