Provider Demographics
NPI:1609270271
Name:OUELLETTE, JEAN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:OUELLETTE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 CHESTNUT ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:FOXBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02035-1472
Mailing Address - Country:US
Mailing Address - Phone:508-698-3709
Mailing Address - Fax:508-698-3785
Practice Address - Street 1:16 CHESTNUT ST
Practice Address - Street 2:SUITE 310
Practice Address - City:FOXBORO
Practice Address - State:MA
Practice Address - Zip Code:02035-1472
Practice Address - Country:US
Practice Address - Phone:508-698-3709
Practice Address - Fax:508-698-3785
Is Sole Proprietor?:No
Enumeration Date:2014-10-10
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1088235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist