Provider Demographics
NPI:1497024376
Name:POULIN, DOREEN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DOREEN
Middle Name:
Last Name:POULIN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 PONDFIELD RD W
Mailing Address - Street 2:APT. 5C
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-2955
Mailing Address - Country:US
Mailing Address - Phone:516-658-5338
Mailing Address - Fax:
Practice Address - Street 1:45 PONDFIELD RD W
Practice Address - Street 2:APT. 5C
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-2955
Practice Address - Country:US
Practice Address - Phone:516-658-5338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005651-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist