Provider Demographics
NPI:1508916388
Name:TDS SPEECH PATHOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:TDS SPEECH PATHOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOMBARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-323-0550
Mailing Address - Street 1:13 MAIN ST.
Mailing Address - Street 2:PO BOX 1080
Mailing Address - City:BELCHERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01007
Mailing Address - Country:US
Mailing Address - Phone:413-323-0550
Mailing Address - Fax:413-323-0555
Practice Address - Street 1:13 MAIN ST.
Practice Address - Street 2:
Practice Address - City:BELCHERTOWN
Practice Address - State:MA
Practice Address - Zip Code:01007
Practice Address - Country:US
Practice Address - Phone:413-323-0550
Practice Address - Fax:413-323-0555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty