Provider Demographics
NPI:1174707327
Name:MCELLIGOTT, MAUREEN KATHERINE (MS, CCC SP)
Entity type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:KATHERINE
Last Name:MCELLIGOTT
Suffix:
Gender:F
Credentials:MS, CCC SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1214
Mailing Address - Street 2:54591 ADAMS
Mailing Address - City:IDYLLWILD
Mailing Address - State:CA
Mailing Address - Zip Code:92549-1214
Mailing Address - Country:US
Mailing Address - Phone:909-953-0157
Mailing Address - Fax:
Practice Address - Street 1:54591 ADAMS
Practice Address - Street 2:
Practice Address - City:IDYLLWILD
Practice Address - State:CA
Practice Address - Zip Code:92549
Practice Address - Country:US
Practice Address - Phone:909-953-0157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 2935235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist