Provider Demographics
NPI:1053447359
Name:WYLONIS, NORRAINE CAROLINE (MS)
Entity Type:Individual
Prefix:MS
First Name:NORRAINE
Middle Name:CAROLINE
Last Name:WYLONIS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 HINGHAM ST
Mailing Address - Street 2:SUITE 101 N
Mailing Address - City:ROCKLAND
Mailing Address - State:MA
Mailing Address - Zip Code:02370-1074
Mailing Address - Country:US
Mailing Address - Phone:781-871-6202
Mailing Address - Fax:781-871-6123
Practice Address - Street 1:800 HINGHAM ST
Practice Address - Street 2:SUITE 101 N
Practice Address - City:ROCKLAND
Practice Address - State:MA
Practice Address - Zip Code:02370-1074
Practice Address - Country:US
Practice Address - Phone:781-871-6202
Practice Address - Fax:781-871-6123
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MASP3194-SL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MASG0001OtherBCBSMA
MA36132OtherHARVARD PILGRIM HEALTH CA
MASP0002OtherBCBSMA
MA723811OtherTUFTS HEALTH PLAN