Provider Demographics
NPI:1740486877
Name:POULIN, LINDA ANN (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:ANN
Last Name:POULIN
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 1:396 CHAMPLAIN ST
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03570-2313
Mailing Address - Country:US
Mailing Address - Phone:603-752-7821
Mailing Address - Fax:
Practice Address - Street 1:396 CHAMPLAIN ST
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NH
Practice Address - Zip Code:03570-2313
Practice Address - Country:US
Practice Address - Phone:603-752-1144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1033235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist