Provider Demographics
NPI:1669152112
Name:HEBERT, CORYNN MARGUERITE (CF-SLP)
Entity type:Individual
Prefix:
First Name:CORYNN
Middle Name:MARGUERITE
Last Name:HEBERT
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25455 BOROUGH PARK DR APT 423
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3590
Mailing Address - Country:US
Mailing Address - Phone:228-284-7055
Mailing Address - Fax:
Practice Address - Street 1:19241 DAVID MEMORIAL DR STE 170A
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77385-8786
Practice Address - Country:US
Practice Address - Phone:936-321-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121245235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist