Provider Demographics
NPI:1346474186
Name:FLETCHER, SUSAN (MS, CCC-SP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:MS, CCC-SP
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 OF GREATER BOSTON
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:508-359-8158
Practice Address - Street 1:5 N MEADOWS RD
Practice Address - Street 2:SPEECH-LANGUAGE & HEARING ASSOCIATES OF GREATER BOSTON
Practice Address - City:MEDFIELD
Practice Address - State:MA
Practice Address - Zip Code:02052-2317
Practice Address - Country:US
Practice Address - Phone:508-359-4532
Practice Address - Fax:508-359-8158
Is Sole Proprietor?:No
Enumeration Date:2009-05-07
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7056235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA226538OtherMEDICARE ORF FACILITY PART A
MA3668706OtherAETNA
MA620733OtherTUFTS
MA626557OtherHARVARD PILGRIM HEALTH CARE
MASG 0013OtherBLUE CROSS BLUE SHIELD GROUP