Healthcare Provider Details

I. General information

NPI: 1972680403
Provider Name (Legal Business Name): ANNE RYDER M.A. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 06/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 LOWELL ST IRONSTONE FARM THERAPY
ANDOVER MA
01810-5305
US

IV. Provider business mailing address

450 LOWELL ST IRONSTONE FARM THERAPY
ANDOVER MA
01810-5305
US

V. Phone/Fax

Practice location:
  • Phone: 978-475-4056
  • Fax: 978-475-4046
Mailing address:
  • Phone: 978-475-4056
  • Fax: 978-475-4046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number6762
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: