Provider Demographics
NPI:1871264044
Name:HARVEY, CAILEEN (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CAILEEN
Middle Name:
Last Name:HARVEY
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-5806
Mailing Address - Country:US
Mailing Address - Phone:607-759-1577
Mailing Address - Fax:
Practice Address - Street 1:34 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-5806
Practice Address - Country:US
Practice Address - Phone:781-591-3499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-27
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ9582235Z00000X
MA78455-SP-SL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty