Healthcare Provider Details

I. General information

NPI: 1790517365
Provider Name (Legal Business Name): PROVIDENT SPEECH PATHOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 WASHINGTON ST
WARREN RI
02885-3317
US

IV. Provider business mailing address

PO BOX 652
WARREN RI
02885-0652
US

V. Phone/Fax

Practice location:
  • Phone: 401-297-3155
  • Fax:
Mailing address:
  • Phone: 401-297-3155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MIRIAM E. DUVEL
Title or Position: OWNER
Credential: MA CCC-SLP
Phone: 401-374-6163