=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801045604
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOBERT PEDIATRICS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2008
-----------------------------------------------------
Last Update Date | 09/17/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12860 HILLCREST RD SUITE 217
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-386-7086
-----------------------------------------------------
Fax | 972-386-4373
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PMB 138 3948 LEGACY DRIVE STE 106
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-386-7086
-----------------------------------------------------
Fax | 972-386-4373
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. JULIE HOBERT
-----------------------------------------------------
Credential | M.A., CCC/SLP
-----------------------------------------------------
Telephone | 972-386-7086
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 15066
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------