Basic Information
| Provider Information | |||||||||
| NPI: | 1841631942 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOUSEL | ||||||||
| FirstName: | MAUREEN | ||||||||
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| Credential: | MS CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 190 NORTH AVE | ||||||||
| Address2: | |||||||||
| City: | AVON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 144141057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5855205129 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1882 WINTON RD S STE 8 | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146183950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5856971557 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2013 | ||||||||
| LastUpdateDate: | 02/24/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 027775-1 | NY | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 05220728 | 05 | NY | MEDICAID |