Healthcare Provider Details

I. General information

NPI: 1245490580
Provider Name (Legal Business Name): EMILY OBRIEN M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 01/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 DERBY ST
NEWTON MA
02465-1555
US

IV. Provider business mailing address

125 DERBY ST
NEWTON MA
02465-1555
US

V. Phone/Fax

Practice location:
  • Phone: 617-559-9500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number16237
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7638
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: