Provider Demographics
NPI:1548591621
Name:VREDENBURGH, MAUREEN RENEE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:RENEE
Last Name:VREDENBURGH
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MISS
Other - First Name:MAUREEN
Other - Middle Name:RENEE
Other - Last Name:MCCABE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:4902 EDGEWORTH DR
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-2109
Mailing Address - Country:US
Mailing Address - Phone:315-359-6900
Mailing Address - Fax:315-359-6900
Practice Address - Street 1:5820 HERITAGE LANDING DR
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9378
Practice Address - Country:US
Practice Address - Phone:315-326-3351
Practice Address - Fax:315-701-1131
Is Sole Proprietor?:No
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012107-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist