Provider Demographics
NPI:1841771896
Name:PIKE, AUDREY MARIE (SPEECH LANGUAGE PATH)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:MARIE
Last Name:PIKE
Suffix:
Gender:F
Credentials:SPEECH LANGUAGE PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 INDIAN NECK RD
Mailing Address - Street 2:
Mailing Address - City:WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02571-2174
Mailing Address - Country:US
Mailing Address - Phone:508-295-3484
Mailing Address - Fax:
Practice Address - Street 1:50 INDIAN NECK RD
Practice Address - Street 2:
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571-2174
Practice Address - Country:US
Practice Address - Phone:508-295-3484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5264235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist