Provider Demographics
NPI:1437655370
Name:DODGE-HOBSON, MARY CYNTHIA (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CYNTHIA
Last Name:DODGE-HOBSON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95A FOURTH ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2900
Mailing Address - Country:US
Mailing Address - Phone:603-970-1653
Mailing Address - Fax:
Practice Address - Street 1:95A FOURTH ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2900
Practice Address - Country:US
Practice Address - Phone:603-970-1653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-31
Last Update Date:2018-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0264235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0264OtherNH STATE LICENSE