Individual
MS. MARY LOU MCCORMICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S. 2917-154 CCC
Contact information
Practice address
4005 TOKAY BLVD, MADISON, WI 53711-1677
(608) 238-7458
(608) 527-4392
Mailing address
4005 TOKAY BLVD, MADISON, WI 53711-1677
(608) 238-7458
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2917 - 154
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01120904
AMERICAN SPEECH LANGUAGE
WI
01
—
2917 -154
WISCONSIN STATE LICENSE
WI
Enumeration date
05/16/2007
Last updated
07/08/2007
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