Provider Demographics
NPI:1235231424
Name:FERRULLI, PETER A (MA CCC SLP)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:A
Last Name:FERRULLI
Suffix:
Gender:M
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 366
Mailing Address - Street 2:ROUTE 6
Mailing Address - City:WYSOX
Mailing Address - State:PA
Mailing Address - Zip Code:18854
Mailing Address - Country:US
Mailing Address - Phone:570-265-3993
Mailing Address - Fax:570-265-8146
Practice Address - Street 1:OLD BLUE HOUSE
Practice Address - Street 2:ROUTE 6
Practice Address - City:WYSOX
Practice Address - State:PA
Practice Address - Zip Code:18854
Practice Address - Country:US
Practice Address - Phone:570-265-3993
Practice Address - Fax:570-265-8146
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL006963L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist