Provider Demographics
NPI:1316482011
Name:COLE, MARY JO (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:JO
Last Name:COLE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:JO
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:4444 CORONA DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4324
Mailing Address - Country:US
Mailing Address - Phone:361-854-1110
Mailing Address - Fax:
Practice Address - Street 1:4444 CORONA DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4324
Practice Address - Country:US
Practice Address - Phone:361-854-1110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-04
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111659235Z00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist