Provider Demographics
NPI:1679098123
Name:CHILDREN'S COMMUNICATION CENTER
Entity Type:Organization
Organization Name:CHILDREN'S COMMUNICATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-313-5461
Mailing Address - Street 1:171 DWIGHT RD STE 300
Mailing Address - Street 2:
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-1768
Mailing Address - Country:US
Mailing Address - Phone:413-313-5461
Mailing Address - Fax:
Practice Address - Street 1:171 DWIGHT RD STE 300
Practice Address - Street 2:
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106-1768
Practice Address - Country:US
Practice Address - Phone:413-313-5461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6108235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA70010000SP0389OtherBLUE CROSS BLUE SHIELD