Healthcare Provider Details

I. General information

NPI: 1932478682
Provider Name (Legal Business Name): MAURIE BETH HAZLEWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAURIE MILLER

II. Dates (important events)

Enumeration Date: 12/27/2011
Last Update Date: 12/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 WATER ST SUITE 300
KERRVILLE TX
78028-5333
US

IV. Provider business mailing address

2985 FM 2676
HONDO TX
78861-6130
US

V. Phone/Fax

Practice location:
  • Phone: 830-792-3300
  • Fax: 830-792-5771
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12434
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: