Provider Demographics
NPI:1346458700
Name:HERTEL, MARY MICHELLE (SPEECH PATH)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:MICHELLE
Last Name:HERTEL
Suffix:
Gender:F
Credentials:SPEECH PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4106 DELLRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-2713
Mailing Address - Country:US
Mailing Address - Phone:502-893-9121
Mailing Address - Fax:502-742-9330
Practice Address - Street 1:4106 DELLRIDGE DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-2713
Practice Address - Country:US
Practice Address - Phone:502-893-9121
Practice Address - Fax:502-742-9330
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY2670235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist