Healthcare Provider Details

I. General information

NPI: 1346409349
Provider Name (Legal Business Name): AGNIESZKA SERAFIN MSCCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AGNIESZKA ROGOWSKA

II. Dates (important events)

Enumeration Date: 06/04/2008
Last Update Date: 06/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 GRANT RD
DEVENS MA
01434-4468
US

IV. Provider business mailing address

8 TOWLE DR
HOLDEN MA
01520-1266
US

V. Phone/Fax

Practice location:
  • Phone: 978-772-1770
  • Fax:
Mailing address:
  • Phone: 508-829-0449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number6558
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: