Provider Demographics
NPI:1659535417
Name:THE SPEECH AND LANGUAGE DEVELOPMENT CENTER
Entity Type:Organization
Organization Name:THE SPEECH AND LANGUAGE DEVELOPMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH AND LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MODE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC SLP
Authorized Official - Phone:469-320-1700
Mailing Address - Street 1:80 CONGRESS ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-3427
Mailing Address - Country:US
Mailing Address - Phone:413-732-0777
Mailing Address - Fax:413-732-0007
Practice Address - Street 1:8405 STERLING ST STE 203
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-1904
Practice Address - Country:US
Practice Address - Phone:469-320-1700
Practice Address - Fax:469-320-1732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA225X00000X
MA7047261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA42703OtherHEALTH NEW ENGLAND
MA0714224Medicaid
CT732022OtherCONNECTICARE
MASP0231OtherBLUE CROSS BLUE SHIELD