Provider Demographics
NPI:1255858387
Name:ROUFF CONOVER, MARY CATHERINE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CATHERINE
Last Name:ROUFF CONOVER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ROUFF
Other - Last Name:CONOVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:901 W PALMCROFT DR
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7936
Mailing Address - Country:US
Mailing Address - Phone:928-502-8001
Mailing Address - Fax:
Practice Address - Street 1:901 W PALMCROFT DR
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7936
Practice Address - Country:US
Practice Address - Phone:928-502-8001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-29
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP8043235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ311042Medicaid