Provider Demographics
NPI:1487964227
Name:MCGOVERN, MAUREEN ANN (HP)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:ANN
Last Name:MCGOVERN
Suffix:
Gender:F
Credentials:HP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14400 AMBAUM BLVD SW STE G
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-1447
Mailing Address - Country:US
Mailing Address - Phone:206-246-8677
Mailing Address - Fax:206-431-2922
Practice Address - Street 1:14400 AMBAUM BLVD SW STE G
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-1447
Practice Address - Country:US
Practice Address - Phone:206-246-8677
Practice Address - Fax:206-431-2922
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHA60135899237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist