Provider Demographics
NPI:1700135175
Name:CHRETIEN, MARY JOANNE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:JOANNE
Last Name:CHRETIEN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:JOANNE
Other - Last Name:COSENTINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:2 TRAY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:FOSTER
Mailing Address - State:RI
Mailing Address - Zip Code:02825-1281
Mailing Address - Country:US
Mailing Address - Phone:401-524-0919
Mailing Address - Fax:
Practice Address - Street 1:2 TRAY HOLLOW RD
Practice Address - Street 2:
Practice Address - City:FOSTER
Practice Address - State:RI
Practice Address - Zip Code:02825-1281
Practice Address - Country:US
Practice Address - Phone:401-524-0919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002228235Z00000X
RISP00515235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist