Provider Demographics
NPI:1194242354
Name:LAWLESS, MARY KATHERINE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATHERINE
Last Name:LAWLESS
Suffix:
Gender:F
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 1:4986 WADESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26133-8362
Mailing Address - Country:US
Mailing Address - Phone:330-401-7800
Mailing Address - Fax:
Practice Address - Street 1:4986 WADESVILLE RD
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:WV
Practice Address - Zip Code:26133-8362
Practice Address - Country:US
Practice Address - Phone:330-401-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-28
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSLP.13937235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist