Healthcare Provider Details

I. General information

NPI: 1417712381
Provider Name (Legal Business Name): MARY REZENDES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 BROOKLINE ST
TOWNSEND MA
01469-1521
US

IV. Provider business mailing address

15 SPRING ST
SHREWSBURY MA
01545-2354
US

V. Phone/Fax

Practice location:
  • Phone: 508-737-8825
  • Fax:
Mailing address:
  • Phone: 508-737-8825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP100024
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: