Provider Demographics
NPI:1548570153
Name:SPEECH LANGUAGE PATHOLOGY CENTER
Entity Type:Organization
Organization Name:SPEECH LANGUAGE PATHOLOGY CENTER
Other - Org Name:TAMMY TAYLOR
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER, SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:781-792-2700
Mailing Address - Street 1:99 LONGWATER CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1643
Mailing Address - Country:US
Mailing Address - Phone:781-792-2700
Mailing Address - Fax:781-792-2707
Practice Address - Street 1:99 LONGWATER CIR
Practice Address - Street 2:SUITE 101
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1642
Practice Address - Country:US
Practice Address - Phone:781-792-2700
Practice Address - Fax:781-792-2707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-15
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7700235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS100263156OtherMEDICARE PTAN