Provider Demographics
NPI:1548229198
Name:TYRRELL, MAUREEN (MA,CCC,SLP)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:
Last Name:TYRRELL
Suffix:
Gender:F
Credentials:MA,CCC,SLP
Other - Prefix:MRS
Other - First Name:MAUREEN
Other - Middle Name:
Other - Last Name:CROSS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA,SLP,CCC
Mailing Address - Street 1:3500 ABBOTTS MILL DR
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-6473
Mailing Address - Country:US
Mailing Address - Phone:216-280-0309
Mailing Address - Fax:
Practice Address - Street 1:1929A E ROYALTON RD
Practice Address - Street 2:
Practice Address - City:BROADVIEW HTS
Practice Address - State:OH
Practice Address - Zip Code:44147-2809
Practice Address - Country:US
Practice Address - Phone:440-838-0990
Practice Address - Fax:440-838-8440
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-7605235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH314380051027OtherCARESOURCE INS. CO.
OH0849916Medicaid