Basic Information
| Provider Information | |||||||||
| NPI: | 1104326552 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUEBNER | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.C.D. CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 514 NOTTINGHAM OAKS TRL | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770796332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7138183892 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1240 BLALOCK RD STE 170 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770556447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134680300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2018 | ||||||||
| LastUpdateDate: | 02/12/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 111202 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 111202 | 01 | TX | ASHA | OTHER |