Provider Demographics
NPI:1326529744
Name:HOPPER, MARY CHRISTINE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CHRISTINE
Last Name:HOPPER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 SHADY OAKS
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:TX
Mailing Address - Zip Code:76531-1241
Mailing Address - Country:US
Mailing Address - Phone:254-784-0519
Mailing Address - Fax:254-386-8644
Practice Address - Street 1:1010 SHADY OAKS
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:TX
Practice Address - Zip Code:76531-1241
Practice Address - Country:US
Practice Address - Phone:254-784-0519
Practice Address - Fax:254-386-8644
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24820235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX24820OtherLICENSE IN SPEECH-LANGUAGE PATHOLOGY