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Provider Information for 1710953534

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: MALE

Individual NPI: 1710953534

Calendar   Last Updated:  2007-07-08
  Certification Date: 


Name Value
NPI 1710953534
Enumeration Date 2006-02-23
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 106 POPE RD
ACTON, MA 01720-5626
United States

Phone: 978-263-1456 | Fax:
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Primary Practice Address 9 HOPE AVE
WALTHAM, MA 02453-2741
United States

Phone: 781-216-2200 | Fax: 781-647-8914
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 235Z00000X - Speech-Language Pathologist MA 1308