Provider Demographics
NPI:1336813906
Name:DULAC, MADELINE ELIZABETH (MA CF SLP)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:ELIZABETH
Last Name:DULAC
Suffix:
Gender:F
Credentials:MA CF SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2539 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15241-2500
Mailing Address - Country:US
Mailing Address - Phone:724-941-4434
Mailing Address - Fax:
Practice Address - Street 1:6502 LILAC ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-3034
Practice Address - Country:US
Practice Address - Phone:412-529-4035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAYYM102865623001OtherHIGHMARK BLUE CROSS BLUE SHIELD