Provider Demographics
NPI:1538691522
Name:UNIVERSITY OF MASSACHUSETTS
Entity Type:Organization
Organization Name:UNIVERSITY OF MASSACHUSETTS
Other - Org Name:CENTER FOR LANGUAGE, SPEECH AND HEARING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE CHANCELLOR FOR COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-545-2148
Mailing Address - Street 1:358 N PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01003-9296
Mailing Address - Country:US
Mailing Address - Phone:413-545-2565
Mailing Address - Fax:413-545-8670
Practice Address - Street 1:358 N PLEASANT ST
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01003-9296
Practice Address - Country:US
Practice Address - Phone:413-545-2565
Practice Address - Fax:413-545-8670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA491231H00000X
MA5987235Z00000X
MA76417235Z00000X
MA7055235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty