Provider Demographics
NPI:1336665694
Name:HARTZELL, MARIAH NICOLE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:NICOLE
Last Name:HARTZELL
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 1:724 24TH AVE NW STE 100
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6214
Mailing Address - Country:US
Mailing Address - Phone:405-447-1571
Mailing Address - Fax:
Practice Address - Street 1:724 24TH AVE NW STE 100
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6214
Practice Address - Country:US
Practice Address - Phone:405-447-1571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-18
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5471235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist