1538609029 NPI number — GREATER LOWELL SPEECH THERAPY LLC

Table of content: (NPI 1538609029)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538609029 NPI number — GREATER LOWELL SPEECH THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREATER LOWELL SPEECH THERAPY LLC
Provider Last Name:
Provider First Name:
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Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
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Provider Other Last Name:
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NPI Number Information

NPI Number:
1538609029
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/02/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16 STRATTON HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTFORD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01886-1923
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 COURTHOUSE LN UNIT B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHELMSFORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01824-1728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-376-4370
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/02/2017

Additional Information

Authorized Official

Authorized Official Last Name:
STAPLES
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
SPEECH LANGUAGE PATHOLOGIST
Authorized Official Telephone Number:
978-376-4370

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  6548 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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