Provider Demographics
NPI:1790094381
Name:FONOS, SHARON LILLIAN (MS CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:SHARON
Middle Name:LILLIAN
Last Name:FONOS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:484 MAIN STREET
Mailing Address - Street 2:EASTER SEALS MASSACHUSETTS
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1893
Mailing Address - Country:US
Mailing Address - Phone:800-244-2756
Mailing Address - Fax:508-831-9768
Practice Address - Street 1:484 MAIN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1893
Practice Address - Country:US
Practice Address - Phone:800-244-2756
Practice Address - Fax:508-831-9768
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7983235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist