Provider Demographics
NPI:1124585138
Name:MARSHFIELD SPEECH AND LANGUAGE THERAPY LLC
Entity Type:Organization
Organization Name:MARSHFIELD SPEECH AND LANGUAGE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LENNON
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:781-566-0575
Mailing Address - Street 1:55 MARSHHAWK WAY
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-2669
Mailing Address - Country:US
Mailing Address - Phone:781-566-0575
Mailing Address - Fax:
Practice Address - Street 1:55 MARSHHAWK WAY
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MA
Practice Address - Zip Code:02050-2669
Practice Address - Country:US
Practice Address - Phone:781-566-0575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA8619OtherDIVISION OF PROFESSIONAL LICENSURE