Individual
MARY BETH TINNEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
400 OLD MAIN DR, SUMMERSVILLE, WV 26651-1360
(304) 872-3611
Mailing address
PO BOX 131, LEIVASY, WV 26676-0131
(304) 846-2077
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP-1066
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SLP-1066
LICENSURE
WV
Enumeration date
06/04/2007
Last updated
03/04/2008
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