Provider Demographics
NPI:1962774836
Name:DOUGHERTY, DOROTHY PAGLIONE (MA)
Entity type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:PAGLIONE
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 WABASH AVENUE
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221
Mailing Address - Country:US
Mailing Address - Phone:609-926-1435
Mailing Address - Fax:609-926-4153
Practice Address - Street 1:1910 WABASH AVE
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1451
Practice Address - Country:US
Practice Address - Phone:609-926-1435
Practice Address - Fax:609-926-4153
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00133800235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist