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NPI Code Detail

MEDICARE: MRS. MARY BETH HACKETT B.S. IN SPEECH

MEDICARE: MRS. MARY BETH HACKETT B.S. IN SPEECH
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
1235Z00000XSpeech-Language Pathologist3849437AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1467575811
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARY BETH HACKETT B.S. IN SPEECH
Provider Business Mailing Address
First Line : 4304 E CAMPBELL AVE
Second Line : APT # 1070
City : PHOENIX
State : AZ
Zip : 85018-3701
Country : US
Telephone Number : 602-326-3061
Fax Number :
Provider Business Practice Location Address
First Line : 6218 S 7TH ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85042-4211
Country : US
Telephone Number : 602-326-3061
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2007
Last Update Date : 07/08/2007

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