Provider Demographics
NPI:1962547604
Name:SEITZ, MARY M (SLP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:M
Last Name:SEITZ
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 1:66 MARINERO WAY
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:71909-6700
Mailing Address - Country:US
Mailing Address - Phone:501-915-0627
Mailing Address - Fax:
Practice Address - Street 1:220 MINORCA RD
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71909-6505
Practice Address - Country:US
Practice Address - Phone:501-922-4490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#1647235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARSP # 1647OtherAR. BOARD OF EXAMINERS
09144233OtherAM. SLP ASSOC.