Provider Demographics
NPI:1871902270
Name:REARDON, MARY LOU (MA, SLP/ CCC)
Entity type:Individual
Prefix:MRS
First Name:MARY LOU
Middle Name:
Last Name:REARDON
Suffix:
Gender:F
Credentials:MA, SLP/ CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6740 LOVELAND MIAMIVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-8795
Mailing Address - Country:US
Mailing Address - Phone:513-697-3045
Mailing Address - Fax:513-683-1584
Practice Address - Street 1:6740 LOVELAND MIAMIVILLE RD
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-8795
Practice Address - Country:US
Practice Address - Phone:513-697-3045
Practice Address - Fax:513-683-1584
Is Sole Proprietor?:No
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP 4257235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist