Provider Demographics
NPI:1104058601
Name:HEBERT, MARY (MS)
Entity type:Individual
Prefix:MISS
First Name:MARY
Middle Name:
Last Name:HEBERT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 HAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:DEL CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73115-1453
Mailing Address - Country:US
Mailing Address - Phone:405-245-6955
Mailing Address - Fax:
Practice Address - Street 1:1700 HAMPTON DR
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-1453
Practice Address - Country:US
Practice Address - Phone:405-245-6955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKTEMPORARY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist