Provider Demographics
NPI:1184690497
Name:BOLEA, MARY KATHLEEN
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATHLEEN
Last Name:BOLEA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HIGHTOWER BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15205-1134
Mailing Address - Country:US
Mailing Address - Phone:412-787-1180
Mailing Address - Fax:412-787-1156
Practice Address - Street 1:100 HIGHTOWER BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15205-1134
Practice Address - Country:US
Practice Address - Phone:412-787-1180
Practice Address - Fax:412-787-1156
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL000896L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist