Mary Randall Ivy, MSDE

NPI #1932874385 in Brentwood, Missouri

Provider Information

NPI Number: 1932874385
Entity Type: Individual
Name: Mary Randall Ivy, MSDE
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Developmental Therapist
Credential: MSDE
Enumeration Date: Aug 9, 2021
Last Updated: Aug 9, 2021

Practice Location

Address: 1314 STRASSNER DR
City: Brentwood
State: Missouri
ZIP Code: 63144-1873
Phone: (314) 918-1369

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Developmental Therapist	222Q00000X	Primary

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