Provider Demographics
NPI:1619068517
Name:HINDAL, MARY LYNN (SPEECH LANGUAGE PATH)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LYNN
Last Name:HINDAL
Suffix:
Gender:F
Credentials:SPEECH LANGUAGE PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16209 E ROSETTA DR UNIT 41
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-3801
Mailing Address - Country:US
Mailing Address - Phone:503-369-2223
Mailing Address - Fax:
Practice Address - Street 1:16800 E PAUL NORDIN PKWY
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-0002
Practice Address - Country:US
Practice Address - Phone:503-369-2223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP13416235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR027992OtherOMAP