Provider Demographics
NPI:1770816316
Name:FOGARTY, M. MAURINE (MS, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:M.
Middle Name:MAURINE
Last Name:FOGARTY
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 1:7067 TIFFANY BLVD.
Mailing Address - Street 2:
Mailing Address - City:POLAND,
Mailing Address - State:OH
Mailing Address - Zip Code:44514
Mailing Address - Country:US
Mailing Address - Phone:330-726-7411
Mailing Address - Fax:330-726-6911
Practice Address - Street 1:7067 TIFFANY BLVD.
Practice Address - Street 2:
Practice Address - City:POLAND,
Practice Address - State:OH
Practice Address - Zip Code:44514
Practice Address - Country:US
Practice Address - Phone:330-726-7411
Practice Address - Fax:330-726-6911
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP0042235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist