Provider Demographics
NPI:1255060471
Name:HERBERT, MARY KAYE
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KAYE
Last Name:HERBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:GRANITE SCHOOL DISTRICT
Mailing Address - Street 2:OAKWOOD ELEMENTARY-5815 SOUTH HIGHLAND DRIVE
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84121
Mailing Address - Country:US
Mailing Address - Phone:385-646-4942
Mailing Address - Fax:
Practice Address - Street 1:OAKWOOD ELEMENTARY
Practice Address - Street 2:5815 SOUTH HIGHLAND DRIVE
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84121
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool