Basic Information
| Provider Information | |||||||||
| NPI: | 1619068517 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HINDAL | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | |||||||||
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| Credential: | SPEECH LANGUAGE PATH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16209 E ROSETTA DR UNIT 41 | ||||||||
| Address2: | |||||||||
| City: | FOUNTAIN HILLS | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852683801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033692223 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 16800 E PAUL NORDIN PKWY | ||||||||
| Address2: | |||||||||
| City: | FOUNTAIN HILLS | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852680002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033692223 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2006 | ||||||||
| LastUpdateDate: | 05/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SLP13416 | AZ | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 027992 | 01 | OR | OMAP | OTHER |