Provider Demographics
NPI:1942270574
Name:SPEECH-LANGUAGE AND HEARING ASSOCIATES OF GREATER BOSTON, PC
Entity Type:Organization
Organization Name:SPEECH-LANGUAGE AND HEARING ASSOCIATES OF GREATER BOSTON, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURA
Authorized Official - Middle Name:G
Authorized Official - Last Name:MARKS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD AUD CCC-A/SLP
Authorized Official - Phone:508-359-8158
Mailing Address - Street 1:5 NORTH MEADOWS RD
Mailing Address - Street 2:SLP ASSOCIATES PC
Mailing Address - City:MEDFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02052-2317
Mailing Address - Country:US
Mailing Address - Phone:508-359-4532
Mailing Address - Fax:508-359-0198
Practice Address - Street 1:5 NORTH MEADOWS RD
Practice Address - Street 2:SLP ASSOCIATES PC
Practice Address - City:MEDFIELD
Practice Address - State:MA
Practice Address - Zip Code:02052-2317
Practice Address - Country:US
Practice Address - Phone:508-359-4532
Practice Address - Fax:508-359-0198
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPEECH-LANGUAGE AND HEARING ASSOCIATES OF GREATER BOSTON, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-25
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1093974073OtherMEDICARE B
MA3668706OtherAETNA
MA620733OtherTUFTS
MA626557OtherHARVARD PILGRIM
MA226538OtherMEDICARE A ORF
MASG0013OtherBLUE CROSS GROUP