MEDICARE: CHILDREN'S COMMUNICATION CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	6108	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	70010000SP0389	OTHER	MA	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1679098123
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDREN'S COMMUNICATION CENTER

Provider Business Mailing Address
First Line	:	171 DWIGHT RD STE 300
Second Line	:
City	:	LONGMEADOW
State	:	MA
Zip	:	01106-1768
Country	:	US
Telephone Number	:	413-313-5461
Fax Number	:

Provider Business Practice Location Address
First Line	:	171 DWIGHT RD STE 300
Second Line	:
City	:	LONGMEADOW
State	:	MA
Zip	:	01106-1768
Country	:	US
Telephone Number	:	413-313-5461
Fax Number	:

Authorized Official
Title or Position	:	SPEECH-LANGUAGE PATHOLOGIST/OWNER
Name	:	DANIELLE MARIE FISHER
Credential	:
Telephone Number	:	413-313-5461

Provider Enumeration Date	:	08/06/2017
Last Update Date	:	07/21/2022

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Directions to “CHILDREN'S COMMUNICATION CENTER ” Practice Location

Language	Start Address	Practice Location

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