MEDICARE: MRS. MARLENE HENNESSEY AUDIOLOGIST

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	231H00000X	Audiologist	50503	TX

General Provider Information

NPI Number	:	1770628240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARLENE HENNESSEY AUDIOLOGIST

Provider Business Mailing Address
First Line	:	117 MEDICAL DR STE 1
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77904-3114
Country	:	US
Telephone Number	:	361-573-4331
Fax Number	:	361-575-6244

Provider Business Practice Location Address
First Line	:	117 MEDICAL DR
Second Line	:	SUITE #1
City	:	VICTORIA
State	:	TX
Zip	:	77904-3102
Country	:	US
Telephone Number	:	361-573-4331
Fax Number	:	361-575-6244

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

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	06/29/2022

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