Individual
MARY BETH HETHERTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
40 HOLLAND ST, SOMERVILLE, MA 02144-2705
(617) 629-6220
Mailing address
147 MILK ST, PROVIDER ENROLLMENT 9TH FLOOR, BOSTON, MA 02109-4806
(617) 559-8051
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3243
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0022118
NEIGHBORHOOD HEALTH PLAN
MA
05
—
0333182
—
MA
01
—
908317
TUFTS HEALTH PLAN
MA
01
—
B501027
CIGNA
MA
01
—
HV0002
HARVARD PILGRIM
MA
01
—
SP0146
BLUE CROSS
MA
Enumeration date
01/26/2006
Last updated
08/27/2007
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