Provider Demographics
NPI:1346505724
Name:SPEECH AND LANGUAGE CENTER
Entity Type:Organization
Organization Name:SPEECH AND LANGUAGE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MODE
Authorized Official - Suffix:
Authorized Official - Credentials:SLPA
Authorized Official - Phone:413-530-9431
Mailing Address - Street 1:171 INTERSTATE DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-5101
Mailing Address - Country:US
Mailing Address - Phone:413-530-9431
Mailing Address - Fax:866-582-8420
Practice Address - Street 1:171 INTERSTATE DR
Practice Address - Street 2:SUITE 3
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-5101
Practice Address - Country:US
Practice Address - Phone:413-530-9431
Practice Address - Fax:866-582-8420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6941225X00000X
MA7047235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty