Provider Demographics
NPI:1326299116
Name:SELL, MAUREEN PILGRIM (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:PILGRIM
Last Name:SELL
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 MORNING GLORY CT
Mailing Address - Street 2:
Mailing Address - City:LAKE WYLIE
Mailing Address - State:SC
Mailing Address - Zip Code:29710-6085
Mailing Address - Country:US
Mailing Address - Phone:704-578-4757
Mailing Address - Fax:
Practice Address - Street 1:4877 CHARLOTTE HWY
Practice Address - Street 2:
Practice Address - City:LAKE WYLIE
Practice Address - State:SC
Practice Address - Zip Code:29710-8096
Practice Address - Country:US
Practice Address - Phone:803-831-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-10
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4388235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist