Provider Demographics
NPI:1386906287
Name:RECORDS, MARY ANN (PHD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:RECORDS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7621 WINGSPREAD ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-3761
Mailing Address - Country:US
Mailing Address - Phone:816-914-2752
Mailing Address - Fax:
Practice Address - Street 1:7621 WINGSPREAD ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084-3761
Practice Address - Country:US
Practice Address - Phone:816-914-2752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO107007235Z00000X
NVSP-1457235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist