Provider Demographics
NPI:1013130046
Name:LALLY, JEANNE MARGUERITE (MS SLP)
Entity Type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:MARGUERITE
Last Name:LALLY
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 325
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01096-0325
Mailing Address - Country:US
Mailing Address - Phone:413-586-7700
Mailing Address - Fax:
Practice Address - Street 1:349 HAYDENVILLE RD
Practice Address - Street 2:
Practice Address - City:LEEDS
Practice Address - State:MA
Practice Address - Zip Code:01053-9767
Practice Address - Country:US
Practice Address - Phone:413-586-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2898235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist