Healthcare Provider Details

I. General information

NPI: 1619969656
Provider Name (Legal Business Name): CAROL PATTESON HEBERT M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3049 36TH ST
PORT ARTHUR TX
77642-5412
US

IV. Provider business mailing address

3049 36TH ST
PORT ARTHUR TX
77642-5412
US

V. Phone/Fax

Practice location:
  • Phone: 409-983-1651
  • Fax: 409-983-1043
Mailing address:
  • Phone: 409-983-1651
  • Fax: 409-983-1043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number15280
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: