Provider Demographics
NPI:1457409658
Name:SHUMAKER, JACEY ZOE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JACEY
Middle Name:ZOE
Last Name:SHUMAKER
Suffix:
Gender:F
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 1:41 HARTFORD ST
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-2402
Mailing Address - Country:US
Mailing Address - Phone:617-930-1370
Mailing Address - Fax:
Practice Address - Street 1:77 WARREN ST
Practice Address - Street 2:BUILDING 4
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-3601
Practice Address - Country:US
Practice Address - Phone:617-930-1370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4737235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MASP0118OtherBCBS PROVIDER NUMBER