=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346173796
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEK PEDIATRIC FEEDING AND COMMUNICATION PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2026
-----------------------------------------------------
Last Update Date | 06/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 578 SUMMER ST
-----------------------------------------------------
City | ST JOHNSBURY
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05819-2146
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-488-4432
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 578 SUMMER ST
-----------------------------------------------------
City | ST JOHNSBURY
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05819-2146
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-488-4432
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPEECH-LANGUAGE PATHOLOGIST
-----------------------------------------------------
Name | GINA DIANE WATSON
-----------------------------------------------------
Credential | MS CCC-SLP
-----------------------------------------------------
Telephone | 802-488-4432
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------