Provider Demographics
NPI:1386761377
Name:ASTORINO, MARYLOU (AUD)
Entity type:Individual
Prefix:
First Name:MARYLOU
Middle Name:
Last Name:ASTORINO
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 ENGBERT RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15902-4513
Mailing Address - Country:US
Mailing Address - Phone:814-536-0401
Mailing Address - Fax:814-535-5299
Practice Address - Street 1:348 BUDFIELD ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3214
Practice Address - Country:US
Practice Address - Phone:814-262-3950
Practice Address - Fax:814-262-3990
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT 000243L231H00000X
PAAT 00243L237600000X
PAAT000243L231HA2400X, 231HA2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier