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Individual
MS. MARY GRACE HOBBY I
Active
Individual
MS. MARY GRACE HOBBY I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP004887
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
197996
BLUE SHIELD
GA
01
—
46478BA1
WELLCARE
GA
01
—
52197809001
EDI ENS
GA
Enumeration date
11/20/2006
Last updated
07/08/2007
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