Provider Demographics
NPI:1942454962
Name:TREGLIA, ETHAN ANDREW (MS, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:ETHAN
Middle Name:ANDREW
Last Name:TREGLIA
Suffix:
Gender:M
Credentials:MS, CCC-SLP
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:150 S. HUNTINGTON AVE
Mailing Address - Street 2:APHASIA RESEARCH CENTER/VA BOSTON HEALTHCARE SYSTEM
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-4817
Mailing Address - Country:US
Mailing Address - Phone:857-364-2631
Mailing Address - Fax:
Practice Address - Street 1:150 S. HUNTINGTON AVE
Practice Address - Street 2:APHASIA RESEARCH CENTER/VA BOSTON HEALTHCARE SYSTEM
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-4817
Practice Address - Country:US
Practice Address - Phone:857-364-2631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MASP 6949-SL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist