Mary Kathleen Hazel, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

7101005942 Issued in MI

Practice address

128 W Huron Ave Ste H
Bad Axe, MI 48413-1177

Phone

(989) 269-6666

NPI assigned

Jan 7, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mary Kathleen Russell Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1546819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672704000000",
    "number": "1720551203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 W HURON AVE",
            "city": "BAD AXE",
            "state": "MI",
            "postal_code": "484131177",
            "telephone_number": "989-269-7666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 W HURON AVE STE H",
            "city": "BAD AXE",
            "state": "MI",
            "postal_code": "484131177",
            "telephone_number": "989-269-6666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAZEL",
        "first_name": "MARY",
        "middle_name": "KATHLEEN",
        "credential": "CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-07",
        "last_updated": "2023-01-03",
        "certification_date": "2023-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MI",
            "license": "7101005942",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "RUSSELL",
            "middle_name": "KATHLEEN",
            "credential": "CCC-SLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Samantha Harris
• Sarah Harris
• Tracey Harwood
• Diana Rose Hass, DDS
• Bethany Hasting
• Hearing Services of Bad Axe
• Heartland Hospice Services, LLC
• Tracie Jo Henline, NP
• Diana Hickey, NP
• Kendra Hill

• Speech-Language Pathologist in Bad Axe, MI
• Providers in Bad Axe, MI by specialty
• Speech-Language Pathologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.