Healthcare Provider Details

I. General information

NPI: 1386389948
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: 04/28/2022
Last Update Date: 04/28/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 N MEADOWS RD
MEDFIELD MA
02052-2317
US

IV. Provider business mailing address

5 N MEADOWS RD
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 TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DR. MAURA G. MARKS
Title or Position: DIRECTOR
Credential: PH.D., AU.D.
Phone: 508-359-4532