Provider Demographics
NPI:1427203280
Name:DEROCHE, MAUREEN A (SLP)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:A
Last Name:DEROCHE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 N MAIN ST
Mailing Address - Street 2:BOOTHBY THERAPY SERVICES
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03246-2603
Mailing Address - Country:US
Mailing Address - Phone:603-524-4385
Mailing Address - Fax:603-524-1497
Practice Address - Street 1:806 N MAIN ST
Practice Address - Street 2:BOOTHBY THERAPY SERVICES
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-2603
Practice Address - Country:US
Practice Address - Phone:603-524-4385
Practice Address - Fax:603-524-1497
Is Sole Proprietor?:No
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0263235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist