Provider Demographics
NPI:1386076461
Name:HUSTON, MARY E (MS-SLP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:HUSTON
Suffix:
Gender:F
Credentials:MS-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 UNIVERSITY AVE W
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58707-0002
Mailing Address - Country:US
Mailing Address - Phone:701-858-3030
Mailing Address - Fax:701-858-3032
Practice Address - Street 1:500 UNIVERSITY AVE W
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58707-0002
Practice Address - Country:US
Practice Address - Phone:701-858-3030
Practice Address - Fax:701-858-3032
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1088235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND55661Medicaid