Provider Demographics
NPI:1851668370
Name:TUCKER, PHOEBE (SLP)
Entity Type:Individual
Prefix:
First Name:PHOEBE
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2326 E MAIN ST
Mailing Address - Street 2:MONTANO ASSISTIVE TECHNOLOGY CENTER
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-1801
Mailing Address - Country:US
Mailing Address - Phone:203-269-3511
Mailing Address - Fax:203-269-7411
Practice Address - Street 1:2326 E MAIN ST
Practice Address - Street 2:MONTANO ASSISTIVE TECHNOLOGY CENTER
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610-1801
Practice Address - Country:US
Practice Address - Phone:203-333-3366
Practice Address - Fax:203-333-3364
Is Sole Proprietor?:No
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001487235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist