Provider Demographics
NPI:1487707519
Name:EADIE, MARY L (SLP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:L
Last Name:EADIE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:L
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:6224 RIVERVALLEY DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-6576
Mailing Address - Country:US
Mailing Address - Phone:615-397-0797
Mailing Address - Fax:
Practice Address - Street 1:6224 RIVERVALLEY DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37221-6576
Practice Address - Country:US
Practice Address - Phone:615-397-0797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSP 0000002412235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist