Individual
MS. DENISE L DOUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, CCC-SLP, MFT
Contact information
Practice address
PO BOX 1155, INDIANA, PA 15701-1155
(724) 349-4978
(724) 349-4990
Mailing address
PO BOX 1155, INDIANA, PA 15701-1155
(724) 349-4978
(724) 349-4990
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SL004074L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013967300001
—
PA
01
—
202285795
TRICARE
—
01
—
DO1753263
HIGHMARK BLUE SHIELD
PA
Enumeration date
07/17/2006
Last updated
04/14/2020
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