Provider Demographics
NPI:1285142208
Name:KLEIN, MARY JOHANNA FOX (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JOHANNA FOX
Last Name:KLEIN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:302 W B ST
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22827-1010
Mailing Address - Country:US
Mailing Address - Phone:540-298-1511
Mailing Address - Fax:540-298-1471
Practice Address - Street 1:302 W B ST
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:VA
Practice Address - Zip Code:22827-1010
Practice Address - Country:US
Practice Address - Phone:540-298-1511
Practice Address - Fax:540-298-1471
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202007740235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist