Provider Demographics
NPI:1639316391
Name:LOEB, RANDI CHUDNOW (MS CCC)
Entity Type:Individual
Prefix:MS
First Name:RANDI
Middle Name:CHUDNOW
Last Name:LOEB
Suffix:
Gender:F
Credentials:MS CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 BEDFORD ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-4500
Mailing Address - Country:US
Mailing Address - Phone:781-862-8085
Mailing Address - Fax:781-862-5337
Practice Address - Street 1:57 BEDFORD ST
Practice Address - Street 2:SUITE 203
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4500
Practice Address - Country:US
Practice Address - Phone:781-862-8085
Practice Address - Fax:781-862-5337
Is Sole Proprietor?:No
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2918235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist