Mary Anne Pultz, M.A., PH.D. , CF-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SI60066569 Issued in WA

Practice address

3121 Squalicum Pkwy
Bellingham, WA 98225-1937

Phone

(360) 734-6760

Fax

(360) 752-0660

NPI assigned

Jan 26, 2009

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts, Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1232928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1232928000000",
    "number": "1083852388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2306 VICTOR ST",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982252237",
            "telephone_number": "360-738-1633",
            "fax_number": "360-752-0660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3121 SQUALICUM PKWY",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982251937",
            "telephone_number": "360-734-6760",
            "fax_number": "360-752-0660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PULTZ",
        "first_name": "MARY",
        "middle_name": "ANNE",
        "name_prefix": "Ms.",
        "credential": "M.A., PH.D. , CF-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-01-26",
        "last_updated": "2009-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WA",
            "license": "SI60066569",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WA",
            "license": "LL60066568",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.