Provider Demographics
NPI:1306117023
Name:OBRIEN, MARY H (AUD,CCC-A)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:H
Last Name:OBRIEN
Suffix:
Gender:F
Credentials:AUD,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6823 ISAACS ORCHARD RD
Mailing Address - Street 2:SUITE 213
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-6096
Mailing Address - Country:US
Mailing Address - Phone:479-750-2080
Mailing Address - Fax:479-750-2082
Practice Address - Street 1:601 W MAPLE AVE
Practice Address - Street 2:SUITE 213
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-5335
Practice Address - Country:US
Practice Address - Phone:479-750-2080
Practice Address - Fax:479-750-2082
Is Sole Proprietor?:No
Enumeration Date:2012-01-26
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR351231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist