Provider Demographics
NPI:1255652244
Name:PELTZ, KIRSTEN (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:PELTZ
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 1:5 N MEADOWS RD
Mailing Address - Street 2:SPEECH-LANGUAGE & HEARING ASSOCIATES
Mailing Address - City:MEDFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02052-2317
Mailing Address - Country:US
Mailing Address - Phone:508-359-4532
Mailing Address - Fax:508-359-0198
Practice Address - Street 1:15 GREEN ST
Practice Address - Street 2:WINGATE AT MELROSE
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-2811
Practice Address - Country:US
Practice Address - Phone:781-664-3950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7755235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA226538OtherMEDICARE A-ORF
MASL-M21875OtherMEDICARE B
MA620733OtherTUFTS
MA626557OtherHARVARD PILGRIM
MASG0013OtherBLUE CROSS BLUE SHIELD