Provider Demographics
NPI:1528128477
Name:HARDAWAY, MARY BETH (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:BETH
Last Name:HARDAWAY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
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Mailing Address - Street 1:PO BOX 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0480
Mailing Address - Country:US
Mailing Address - Phone:251-470-5842
Mailing Address - Fax:251-470-5809
Practice Address - Street 1:1504 SPRINGHILL AVE
Practice Address - Street 2:SUITE 1600
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-3207
Practice Address - Country:US
Practice Address - Phone:251-434-3915
Practice Address - Fax:251-434-3802
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL245235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00979219Medicaid
AL51522544OtherBCBS