Healthcare Provider Details

I. General information

NPI: 1093974073
Provider Name (Legal Business Name): SPEECH-LANGUAGE AND HEARING ASSOCIATES OF GREATER BOSTON, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 09/21/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 NORTH MEADOWS RD SPEECH-LANGUAGE & HEARING ASSOCIATES OF GREATER BOSTON
MEDFIELD MA
02052-2317
US

IV. Provider business mailing address

5 NORTH MEADOWS RD SPEECH-LANGUAGE &HEARING ASSOCIATES OF GREATER BOSTON
MEDFIELD MA
02052-2317
US

V. Phone/Fax

Practice location:
  • Phone: 508-359-4532
  • Fax: 508-359-0198
Mailing address:
  • Phone: 508-359-4532
  • Fax: 508-359-0198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: DR. MAURA G MARKS
Title or Position: DIRECTOR
Credential: PHD CCC-A SLP
Phone: 508-359-4532