Provider Demographics
NPI:1538287990
Name:MOODY, MARY HIBBARD (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:HIBBARD
Last Name:MOODY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:600 S COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-3126
Mailing Address - Country:US
Mailing Address - Phone:918-631-2914
Mailing Address - Fax:918-631-3668
Practice Address - Street 1:600 S COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-3126
Practice Address - Country:US
Practice Address - Phone:918-631-2914
Practice Address - Fax:918-631-3668
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK547235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist