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General NPI Number Information
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NPI Number | 1205164738
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Entity Type | Individual
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Provider Name | MICHELLE BOISVERT M.A. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 11/20/2009
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Last Update Date | 12/09/2009
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Provider Practice Location Address
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Address Line | 358 N PLEASANT ST
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City | AMHERST
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State | MA
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Zip | 01003-9296
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Country | US
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Telephone | 413-545-0131
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Fax |
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Provider Business Mailing Address
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Address Line | 49 CHESTERFIELD RD
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City | WILLIAMSBURG
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State | MA
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Zip | 01096-9422
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Country | US
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Telephone | 413-268-2004
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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 | 7083
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License Number State | MA
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