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General NPI Number Information
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NPI Number | 1083826945
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Entity Type | Individual
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Provider Name | ELIZABETH MARIA SMALL MS C.C.C., SLP
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Gender | Female
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 214 LAKE ST CHILD DEVELOPMENT CENTER
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City | SHREWSBURY
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State | MA
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Zip | 01545-3960
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Country | US
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Telephone | 508-856-4202
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Fax |
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Provider Business Mailing Address
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Address Line | 10 FRANKLIN ST
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City | SPENCER
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State | MA
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Zip | 01562-2010
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Country | US
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Telephone | 774-364-0563
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP-5660-SL
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License Number State | MA
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