Healthcare Provider Details

I. General information

NPI: 1306117023
Provider Name (Legal Business Name): MARY H OBRIEN AUD,CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2012
Last Update Date: 01/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W MAPLE AVE SUITE 213
SPRINGDALE AR
72764-5335
US

IV. Provider business mailing address

6823 ISAACS ORCHARD RD SUITE 213
SPRINGDALE AR
72762-6096
US

V. Phone/Fax

Practice location:
  • Phone: 479-750-2080
  • Fax: 479-750-2082
Mailing address:
  • Phone: 479-750-2080
  • Fax: 479-750-2082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number351
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: