Provider Demographics
NPI:1356617864
Name:MACDOUGALL-PAULY, PAULA CHRISTINE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:CHRISTINE
Last Name:MACDOUGALL-PAULY
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 1:5200 N FLAGLER DR
Mailing Address - Street 2:#1406
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2768
Mailing Address - Country:US
Mailing Address - Phone:561-601-8304
Mailing Address - Fax:
Practice Address - Street 1:4405 LAKEWOOD RD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-3414
Practice Address - Country:US
Practice Address - Phone:772-286-9440
Practice Address - Fax:772-283-3061
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ5675235Z00000X
FLSA 11830235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist