Provider Demographics
NPI:1043383748
Name:DWINELL, MAUREEN MORAN (MA CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:MORAN
Last Name:DWINELL
Suffix:
Gender:F
Credentials:MA 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:PO BOX 88
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01966
Mailing Address - Country:US
Mailing Address - Phone:978-283-0996
Mailing Address - Fax:978-546-5899
Practice Address - Street 1:195 SCHOOL STREET
Practice Address - Street 2:FAMILY MEDICAL ASSOCIATES
Practice Address - City:MANCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01944
Practice Address - Country:US
Practice Address - Phone:978-283-0996
Practice Address - Fax:978-546-5899
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA387235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist