Provider Demographics
NPI:1124375332
Name:NORFOLK COUNTY SPEECH SERVICES
Entity Type:Organization
Organization Name:NORFOLK COUNTY SPEECH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC/SLP
Authorized Official - Phone:617-823-9079
Mailing Address - Street 1:450 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-1172
Mailing Address - Country:US
Mailing Address - Phone:617-823-9079
Mailing Address - Fax:781-762-3122
Practice Address - Street 1:594 NAHATAN ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-1445
Practice Address - Country:US
Practice Address - Phone:617-823-9079
Practice Address - Fax:781-762-3122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2214235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0377856Medicaid