Provider Demographics
NPI:1952536302
Name:O'BRIEN, MICHELLE PULEO (MS,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:PULEO
Last Name:O'BRIEN
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 1:7177 DUGWAY RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NY
Mailing Address - Zip Code:13323-4603
Mailing Address - Country:US
Mailing Address - Phone:315-853-6090
Mailing Address - Fax:315-853-3190
Practice Address - Street 1:2 FOUNTAIN ST
Practice Address - Street 2:SUITE 109
Practice Address - City:CLINTON
Practice Address - State:NY
Practice Address - Zip Code:13323-1725
Practice Address - Country:US
Practice Address - Phone:315-853-6090
Practice Address - Fax:315-853-3190
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014074235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist