Provider Demographics
NPI:1699114686
Name:COYLE, M MARY (SLP)
Entity type:Individual
Prefix:MS
First Name:M MARY
Middle Name:
Last Name:COYLE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5020 E DARTMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-7335
Mailing Address - Country:US
Mailing Address - Phone:720-312-7644
Mailing Address - Fax:
Practice Address - Street 1:7200 S ALTON WAY
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-2201
Practice Address - Country:US
Practice Address - Phone:877-489-0790
Practice Address - Fax:720-489-0848
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-23
Last Update Date:2013-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
00426106OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION