Healthcare Provider Details

I. General information

NPI: 1730364589
Provider Name (Legal Business Name): MARYBETH GRIFFIN MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2007
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6634 NEW SULPHUR SPRINGS RD
SAN ANTONIO TX
78263-2534
US

IV. Provider business mailing address

9710 GEMINI DR
SAN ANTONIO TX
78217-3203
US

V. Phone/Fax

Practice location:
  • Phone: 210-648-7861
  • Fax:
Mailing address:
  • Phone: 505-225-4280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number116613
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: