Provider Demographics
NPI:1225539810
Name:NEWTON, MARY ALICE (SLP-CCC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ALICE
Last Name:NEWTON
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 A A MEYERS RD
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70665-7595
Mailing Address - Country:US
Mailing Address - Phone:337-965-0535
Mailing Address - Fax:
Practice Address - Street 1:3918 ATASCOCITA RD APT 536
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396-4460
Practice Address - Country:US
Practice Address - Phone:337-965-0535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111604235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist