Provider Demographics
NPI:1154634202
Name:CAPE COD SPEECH AND LANGUAGE
Entity Type:Organization
Organization Name:CAPE COD SPEECH AND LANGUAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MAE
Authorized Official - Middle Name:
Authorized Official - Last Name:TIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:MS/CCC-SLP, BRS-FD
Authorized Official - Phone:508-255-0076
Mailing Address - Street 1:PO BOX 774
Mailing Address - Street 2:46 MAIN STREET
Mailing Address - City:ORLEANS
Mailing Address - State:MA
Mailing Address - Zip Code:02653-0774
Mailing Address - Country:US
Mailing Address - Phone:508-255-0076
Mailing Address - Fax:888-317-8302
Practice Address - Street 1:46 MAIN ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ORLEANS
Practice Address - State:MA
Practice Address - Zip Code:02653-2441
Practice Address - Country:US
Practice Address - Phone:508-255-0076
Practice Address - Fax:888-317-8302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1436235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty