Provider Demographics
NPI:1396357539
Name:MOYNIHAN, MAUREEN WHITTEMORE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:WHITTEMORE
Last Name:MOYNIHAN
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 1:8 COLE AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-4502
Mailing Address - Country:US
Mailing Address - Phone:210-632-4624
Mailing Address - Fax:
Practice Address - Street 1:4901 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-2080
Practice Address - Country:US
Practice Address - Phone:508-675-1001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113364235Z00000X
RISP01562235Z00000X
MA77564235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist