Provider Demographics
NPI:1942794672
Name:PAULSEN, RANDOLPH (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RANDOLPH
Middle Name:
Last Name:PAULSEN
Suffix:
Gender:M
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MOHAWK RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-3616
Mailing Address - Country:US
Mailing Address - Phone:781-645-6447
Mailing Address - Fax:
Practice Address - Street 1:237 LEXINGTON ST STE 8
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-5985
Practice Address - Country:US
Practice Address - Phone:781-272-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-16
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist