MEDICARE: USM DUBARD SCHOOL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1770612442
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	USM DUBARD SCHOOL

Provider Business Mailing Address
First Line	:	118 COLLEGE DR # 10035
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39406-0001
Country	:	US
Telephone Number	:	601-266-5223
Fax Number	:	601-266-6763

Provider Business Practice Location Address
First Line	:	118 COLLEGE DR # 10035
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39406-0001
Country	:	US
Telephone Number	:	601-266-5223
Fax Number	:	601-266-6763

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. MAUREEN K MARTIN
Credential	:
Telephone Number	:	601-266-5223

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	06/17/2008

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Directions to “USM DUBARD SCHOOL ” Practice Location

Language	Start Address	Practice Location

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