Provider Demographics
NPI:1083852388
Name:PULTZ, MARY ANNE (MA, PHD , CF-SLP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ANNE
Last Name:PULTZ
Suffix:
Gender:F
Credentials:MA, PHD , CF-SLP
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:2306 VICTOR ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-2237
Mailing Address - Country:US
Mailing Address - Phone:360-738-1633
Mailing Address - Fax:360-752-0660
Practice Address - Street 1:3121 SQUALICUM PKWY
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1937
Practice Address - Country:US
Practice Address - Phone:360-734-6760
Practice Address - Fax:360-752-0660
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASI60066569235Z00000X
WALL60066568235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist