Provider Demographics
NPI:1215665682
Name:GENO, MARY C (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:GENO
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14417 HIGHWAY 442 W
Mailing Address - Street 2:
Mailing Address - City:TICKFAW
Mailing Address - State:LA
Mailing Address - Zip Code:70466-3022
Mailing Address - Country:US
Mailing Address - Phone:985-345-2166
Mailing Address - Fax:
Practice Address - Street 1:14417 HIGHWAY 442 W
Practice Address - Street 2:
Practice Address - City:TICKFAW
Practice Address - State:LA
Practice Address - Zip Code:70466-3022
Practice Address - Country:US
Practice Address - Phone:985-345-2166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1981235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist