Provider Demographics
NPI:1609027994
Name:POULLIOTT, MAUREEN
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:POULLIOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 OREGON TRL
Mailing Address - Street 2:
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-1919
Mailing Address - Country:US
Mailing Address - Phone:412-400-1894
Mailing Address - Fax:
Practice Address - Street 1:5 OREGON TRL
Practice Address - Street 2:
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102-1919
Practice Address - Country:US
Practice Address - Phone:412-400-1894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-05
Last Update Date:2008-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL003864L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist