Healthcare Provider Details

I. General information

NPI: 1538691522
Provider Name (Legal Business Name): UNIVERSITY OF MASSACHUSETTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

358 N PLEASANT ST
AMHERST MA
01003-9296
US

IV. Provider business mailing address

358 N PLEASANT ST
AMHERST MA
01003-9296
US

V. Phone/Fax

Practice location:
  • Phone: 413-545-2565
  • Fax: 413-545-8670
Mailing address:
  • Phone: 413-545-2565
  • Fax: 413-545-8670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number491
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number5987
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number76417
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7055
License Number StateMA

VIII. Authorized Official

Name: CHRISTINE WILDA
Title or Position: ASSOCIATE CHANCELLOR FOR COMPLIANCE
Credential:
Phone: 413-545-2148