Provider Demographics
NPI:1104012236
Name:HAZLETT, SHARI A (SLP)
Entity Type:Individual
Prefix:MS
First Name:SHARI
Middle Name:A
Last Name:HAZLETT
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 CENTRAL PKWY S # 2763
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-5022
Mailing Address - Country:US
Mailing Address - Phone:518-325-0008
Mailing Address - Fax:
Practice Address - Street 1:6050 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5252
Practice Address - Country:US
Practice Address - Phone:325-692-1533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4282235Z00000X
NY009153235Z00000X
TX116389235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist