Provider Demographics
NPI:1124092903
Name:GILES, MARY F (CCP-SLP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:F
Last Name:GILES
Suffix:
Gender:F
Credentials:CCP-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 GRAY ST
Mailing Address - Street 2:#2
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1509
Mailing Address - Country:US
Mailing Address - Phone:617-497-7399
Mailing Address - Fax:
Practice Address - Street 1:482 BEDFORD ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-1402
Practice Address - Country:US
Practice Address - Phone:781-672-2376
Practice Address - Fax:781-672-2145
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5407235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist