Provider Demographics
NPI:1902140551
Name:MLACHAK, MARY LOUISE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARY LOUISE
Middle Name:
Last Name:MLACHAK
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10076 HOBBY HORSE LN
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-6824
Mailing Address - Country:US
Mailing Address - Phone:440-358-1914
Mailing Address - Fax:
Practice Address - Street 1:10076 HOBBY HORSE LN
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-6824
Practice Address - Country:US
Practice Address - Phone:440-358-1914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5891235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist