Provider Demographics
NPI:1215262407
Name:BANE, MARY J (CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:J
Last Name:BANE
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 1:5390 S GARLAND WAY
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-7447
Mailing Address - Country:US
Mailing Address - Phone:303-978-9511
Mailing Address - Fax:
Practice Address - Street 1:5390 S GARLAND WAY
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-7447
Practice Address - Country:US
Practice Address - Phone:303-978-9511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist