Mary B. Blue, MA,CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

3781 Issued in SC

Practice address

111 Oakdale Dr
Summerville, SC 29483-2819

Phone

(843) 303-2881

NPI assigned

Jul 16, 2009

Last updated

Jul 16, 2009By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Michelle Lynn Therapy PLC

  dba Fun First Therapy

  • Speech-Language Pathologist
  • East Tawas, MI
  • NPI 1033729603
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1247702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1247702400000",
    "number": "1710117478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 OAKDALE DR",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294832819",
            "telephone_number": "843-303-2881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 OAKDALE DR",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294832819",
            "telephone_number": "843-303-2881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLUE",
        "first_name": "MARY",
        "middle_name": "B.",
        "credential": "MA,CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-07-16",
        "last_updated": "2009-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "SC",
            "license": "3781",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gabriel Blanco, DPT
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• Bluewater Imaging, LLC
• Craig Ashley Blum, M.D.
• Betty L Bly
• Liza Rachel Boaz, MSN, CNM
• Bodhi

• Speech-Language Pathologist in Summerville, SC
• Providers in Summerville, SC by specialty
• Speech-Language Pathologist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.