Provider Demographics
NPI:1609185594
Name:PAMPOLINA, MAGGIE ELAINE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:ELAINE
Last Name:PAMPOLINA
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 1:7346 PARK RD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:TX
Mailing Address - Zip Code:77657-8218
Mailing Address - Country:US
Mailing Address - Phone:409-781-0650
Mailing Address - Fax:
Practice Address - Street 1:101 CANYON LAKE CIR
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:TX
Practice Address - Zip Code:77657-3701
Practice Address - Country:US
Practice Address - Phone:409-781-0650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-27
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105951235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX746002301Medicaid