Provider Demographics
NPI:1295089787
Name:SAUNDERS, MARY J (CCC, SLP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:SAUNDERS
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 1:561 7TH ST W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-3009
Mailing Address - Country:US
Mailing Address - Phone:651-225-4558
Mailing Address - Fax:651-225-9474
Practice Address - Street 1:561 7TH ST W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-3009
Practice Address - Country:US
Practice Address - Phone:651-225-4558
Practice Address - Fax:651-225-9474
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5980235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist