Provider Demographics
NPI:1063726503
Name:HULSE-FABER, MARIE THERESE (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:MARIE
Middle Name:THERESE
Last Name:HULSE-FABER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MS
Other - First Name:MARIE
Other - Middle Name:THERESE
Other - Last Name:HULSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:92 CARSTAIRS RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-3319
Mailing Address - Country:US
Mailing Address - Phone:347-668-6857
Mailing Address - Fax:
Practice Address - Street 1:92 CARSTAIRS RD
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-3319
Practice Address - Country:US
Practice Address - Phone:347-668-6857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008924-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist