Provider Demographics
NPI:1699711986
Name:DOYLE, MARY KATHRYN (MA, CCC-A)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATHRYN
Last Name:DOYLE
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 406153
Mailing Address - Street 2:HEARUSA
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-1876
Mailing Address - Country:US
Mailing Address - Phone:800-528-3277
Mailing Address - Fax:888-888-0009
Practice Address - Street 1:1832 VETERAN'S MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749
Practice Address - Country:US
Practice Address - Phone:631-582-3707
Practice Address - Fax:631-582-3795
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1250-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYM70501Medicare PIN