Individual
MARY KATHERINE DEYO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, CCC-SLP
Contact information
Practice address
24 FOURNIER RD, CONWAY GRAMMAR SCHOOL, CONWAY, MA 01341-9766
(413) 369-4239
Mailing address
24 FOURNIER RD, CONWAY GRAMMAR SCHOOL, CONWAY, MA 01341-9766
(413) 369-4239
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7244
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12102931
ASHA CERTIFICATION
—
01
—
414649
COMMONWEALTH OF MASSACHUSETTS EDUCATOR'S LICENSE
MA
01
—
7244
COMMONWEALTH OF MASSACHUSETTS PROFESSIONAL LICENSE
MA
Enumeration date
06/30/2008
Last updated
08/21/2009
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