Provider Demographics
NPI:1851642953
Name:NEVERS, MAUREEN DACEY (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:DACEY
Last Name:NEVERS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 HEBARD HILL RD
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:VT
Mailing Address - Zip Code:05060-9152
Mailing Address - Country:US
Mailing Address - Phone:802-431-5040
Mailing Address - Fax:
Practice Address - Street 1:1110 HEBARD HILL RD
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:VT
Practice Address - Zip Code:05060-9152
Practice Address - Country:US
Practice Address - Phone:802-431-5040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT8025932235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist