MEDICARE: MARY CHRISTINE HOPPER MS CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	24820	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	24820	OTHER	TX	LICENSE IN SPEECH-LANGUAGE PATHOLOGY

General Provider Information

NPI Number	:	1326529744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY CHRISTINE HOPPER MS CCC-SLP

Provider Business Mailing Address
First Line	:	1010 SHADY OAKS
Second Line	:
City	:	HAMILTON
State	:	TX
Zip	:	76531-1241
Country	:	US
Telephone Number	:	254-784-0519
Fax Number	:	254-386-8644

Provider Business Practice Location Address
First Line	:	1010 SHADY OAKS
Second Line	:
City	:	HAMILTON
State	:	TX
Zip	:	76531-1241
Country	:	US
Telephone Number	:	254-784-0519
Fax Number	:	254-386-8644

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2018
Last Update Date	:	08/23/2018

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Directions to “ MARY CHRISTINE HOPPER MS CCC-SLP” Practice Location

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