Basic Information
| Provider Information | |||||||||
| NPI: | 1336813906 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DULAC | ||||||||
| FirstName: | MADELINE | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | MA CF SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2539 WASHINGTON RD | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152412500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249414434 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6502 LILAC ST | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152173034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4125294035 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2021 | ||||||||
| LastUpdateDate: | 08/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | YYM102865623001 | 01 | PA | HIGHMARK BLUE CROSS BLUE SHIELD | OTHER |