Provider Demographics
NPI:1538443296
Name:TALNACK, MARY PAT (MA CCC-SLP/L)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:PAT
Last Name:TALNACK
Suffix:
Gender:F
Credentials:MA CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 MILHOUSE WAY
Mailing Address - Street 2:
Mailing Address - City:CHESTER SPRINGS
Mailing Address - State:PA
Mailing Address - Zip Code:19425-2122
Mailing Address - Country:US
Mailing Address - Phone:215-801-6924
Mailing Address - Fax:610-524-4739
Practice Address - Street 1:503 MILHOUSE WAY
Practice Address - Street 2:
Practice Address - City:CHESTER SPRINGS
Practice Address - State:PA
Practice Address - Zip Code:19425-2122
Practice Address - Country:US
Practice Address - Phone:215-801-6924
Practice Address - Fax:610-524-4739
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL009658235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist