Provider Demographics
NPI:1689145526
Name:GOMES, ALISON MARIE
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:MARIE
Last Name:GOMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ELM ST
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02779-1405
Mailing Address - Country:US
Mailing Address - Phone:774-218-4128
Mailing Address - Fax:
Practice Address - Street 1:567 DARTMOUTH ST
Practice Address - Street 2:
Practice Address - City:SOUTH DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02748-1826
Practice Address - Country:US
Practice Address - Phone:508-997-7787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist