Healthcare Provider Details

I. General information

NPI: 1225328222
Provider Name (Legal Business Name): STEPHANIE BEJTLICH MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 04/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 OTIS ST
NORTHBOROUGH MA
01532-2459
US

IV. Provider business mailing address

116 RANTOUL ST UNIT 503
BEVERLY MA
01915-4259
US

V. Phone/Fax

Practice location:
  • Phone: 508-898-2688
  • Fax: 508-319-3200
Mailing address:
  • Phone: 617-797-6133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7482
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: