Provider Demographics
NPI:1538710066
Name:HAMILTON, MARY KATHERINE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATHERINE
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 PERKINS AVE
Mailing Address - Street 2:
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-2133
Mailing Address - Country:US
Mailing Address - Phone:727-674-3841
Mailing Address - Fax:
Practice Address - Street 1:414 DAVIS ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-2468
Practice Address - Country:US
Practice Address - Phone:727-674-3841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028608-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist