Provider Demographics
NPI:1952585556
Name:GREENWOOD, JASON J (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:J
Last Name:GREENWOOD
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 1:6 WALNUT ST
Mailing Address - Street 2:UNIT 2
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-6116
Mailing Address - Country:US
Mailing Address - Phone:617-480-3812
Mailing Address - Fax:
Practice Address - Street 1:6 WALNUT ST
Practice Address - Street 2:UNIT 2
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-6116
Practice Address - Country:US
Practice Address - Phone:617-480-3812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4163235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist