Healthcare Provider Details

I. General information

NPI: 1750791034
Provider Name (Legal Business Name): MARY HOBLIT SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2014
Last Update Date: 05/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 E BIDWELL ST SUITE 201
FOLSOM CA
95630-3565
US

IV. Provider business mailing address

1301 E BIDWELL ST SUITE 201
FOLSOM CA
95630-3565
US

V. Phone/Fax

Practice location:
  • Phone: 916-983-5915
  • Fax: 916-983-5906
Mailing address:
  • Phone: 916-983-5915
  • Fax: 916-983-5906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number21443
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: