Provider Demographics
NPI:1619969656
Name:HEBERT, CAROL PATTESON (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:PATTESON
Last Name:HEBERT
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 1:3049 36TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-5412
Mailing Address - Country:US
Mailing Address - Phone:409-983-1651
Mailing Address - Fax:409-983-1043
Practice Address - Street 1:3049 36TH ST
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-5412
Practice Address - Country:US
Practice Address - Phone:409-983-1651
Practice Address - Fax:409-983-1043
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15280235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0933135OtherCIGNA HEALTHCARE OF TX
TX15476OtherUTMB - CHIPS
TX87216TOtherBLUECROSS BLUESHIELD TX
TX746012298001OtherHUMANA MILITARY HEALTHCAR
TX676518Medicare ID - Type UnspecifiedSPEECH PATHOLOGIST