Healthcare Provider Details

I. General information

NPI: 1487980298
Provider Name (Legal Business Name): CHILDREN'S SPEECH AND FEEDING THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2009
Last Update Date: 10/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 WEST ST
NEEDHAM MA
02494-1319
US

IV. Provider business mailing address

150 WEST ST
NEEDHAM MA
02494-1319
US

V. Phone/Fax

Practice location:
  • Phone: 781-726-6209
  • Fax: 781-726-6212
Mailing address:
  • Phone: 781-726-6209
  • Fax: 781-726-6212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number1375
License Number StateMA

VIII. Authorized Official

Name: ARDEN HILL
Title or Position: SPEECH/LANGUAGE PATHOLOGIST
Credential:
Phone: 781-726-6209