=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447980594
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIN HEBERT AUD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2022
-----------------------------------------------------
Last Update Date | 06/13/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 COUNTRY VIEW DR STE 200
-----------------------------------------------------
City | ROANOKE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76262-2055
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-767-9970
-----------------------------------------------------
Fax | 817-333-1190
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4491 LONG PRAIRIE RD STE 400
-----------------------------------------------------
City | FLOWER MOUND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75028-1795
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-997-4084
-----------------------------------------------------
Fax | 817-333-1190
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | 81341
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------