Provider Demographics
NPI:1093260572
Name:DEGGE, MARY CHRISTINE 'TINA' (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CHRISTINE 'TINA'
Last Name:DEGGE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 LYNN LN
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-5128
Mailing Address - Country:US
Mailing Address - Phone:281-706-0760
Mailing Address - Fax:
Practice Address - Street 1:1122 LYNN LN
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-5128
Practice Address - Country:US
Practice Address - Phone:281-706-0760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110707235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist