Provider Demographics
NPI:1922102912
Name:SOUTH EAST CENTER FOR SWALLOWING & COMMUNICATION
Entity Type:Organization
Organization Name:SOUTH EAST CENTER FOR SWALLOWING & COMMUNICATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC SLP
Authorized Official - Phone:508-991-2332
Mailing Address - Street 1:92 GRAPE ST
Mailing Address - Street 2:UNIT 1
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-2143
Mailing Address - Country:US
Mailing Address - Phone:508-991-2332
Mailing Address - Fax:508-991-8437
Practice Address - Street 1:92 GRAPE ST
Practice Address - Street 2:UNIT 1
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-2143
Practice Address - Country:US
Practice Address - Phone:508-991-2332
Practice Address - Fax:508-991-8437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA225X00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAOG0068OtherBLUE CROSS BLUE SHIELD OF MASSACHUSETTS
MAAA14788OtherHARVARD PILGRIM
MASG0002OtherBLUE CROSS BLUE SHIELD OF MASSACHUSETTS
MA691582OtherTUFTS HEALTH PLAN
MA9737570Medicaid
MA=========OtherAETNA
MAAA14788OtherHARVARD PILGRIM
MA9737570Medicaid