Provider Demographics
NPI:1013389071
Name:DURANT, PRISCILLA (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:PRISCILLA
Middle Name:
Last Name:DURANT
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 ROGER GOODWIN DR
Mailing Address - Street 2:
Mailing Address - City:WRENTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02093-1420
Mailing Address - Country:US
Mailing Address - Phone:508-384-6507
Mailing Address - Fax:
Practice Address - Street 1:25 ROGER GOODWIN DR
Practice Address - Street 2:
Practice Address - City:WRENTHAM
Practice Address - State:MA
Practice Address - Zip Code:02093-1420
Practice Address - Country:US
Practice Address - Phone:508-384-6507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3149235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist