Provider Demographics
NPI:1861746695
Name:CRITCHFIELD SCHULTZ, MARY LANE (BS, MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LANE
Last Name:CRITCHFIELD SCHULTZ
Suffix:
Gender:F
Credentials:BS, 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 1:407 EAST WOODIN AVE.
Mailing Address - Street 2:
Mailing Address - City:CHELAN
Mailing Address - State:WA
Mailing Address - Zip Code:98816-9648
Mailing Address - Country:US
Mailing Address - Phone:509-682-4031
Mailing Address - Fax:509-682-8291
Practice Address - Street 1:407 EAST WOODIN AVE.
Practice Address - Street 2:
Practice Address - City:CHELAN
Practice Address - State:WA
Practice Address - Zip Code:98816-9648
Practice Address - Country:US
Practice Address - Phone:509-682-4031
Practice Address - Fax:509-682-8291
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL 00001864235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist