Provider Demographics
NPI:1881091338
Name:LEGOR, CAROLINE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:LEGOR
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 1:18 CLIFTON ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-2620
Mailing Address - Country:US
Mailing Address - Phone:617-448-6290
Mailing Address - Fax:617-830-0268
Practice Address - Street 1:18 CLIFTON ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-2620
Practice Address - Country:US
Practice Address - Phone:617-448-6290
Practice Address - Fax:617-830-0268
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-28
Last Update Date:2014-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6550235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist