Healthcare Provider Details

I. General information

NPI: 1952526279
Provider Name (Legal Business Name): EVELYN FRANCES STERN CCC-SP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 BORDER ST
EAST BOSTON MA
02128-2432
US

IV. Provider business mailing address

36 CUTLER ST APT.1
WINTHROP MA
02152-1281
US

V. Phone/Fax

Practice location:
  • Phone: 617-569-6560
  • Fax: 617-569-1856
Mailing address:
  • Phone: 617-539-1770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1879
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: