1134408362 NPI number — MISS MAURA KATHLEEN DUGAN MA CCC SLP

Table of content: MISS MAURA KATHLEEN DUGAN MA CCC SLP (NPI 1134408362)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134408362 NPI number — MISS MAURA KATHLEEN DUGAN MA CCC SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUGAN
Provider First Name:
MAURA
Provider Middle Name:
KATHLEEN
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
MA CCC SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134408362
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4055 MONROEVILLE BLVD
Provider Second Line Business Mailing Address:
SUIT 110, CORP ONE OFFICE PARK BUILDING ONE
Provider Business Mailing Address City Name:
MONROEVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15146-2522
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-666-3800
Provider Business Mailing Address Fax Number:
412-666-3821

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4055 MONROEVILLE BLVD
Provider Second Line Business Practice Location Address:
SUIT 110, CORP ONE OFFICE PARK BUILDING ONE
Provider Business Practice Location Address City Name:
MONROEVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15146-2522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-666-3800
Provider Business Practice Location Address Fax Number:
412-666-3821
Provider Enumeration Date:
08/05/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SL010541 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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