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General NPI Number Information
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NPI Number | 1497648877
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Entity Type | Organization
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Legal Business Name | SPEECH LANGUAGE NOOK THERAPY CENTER
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Dates
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Enumeration Date | 06/02/2025
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 454 MAIN ST
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City | STURBRIDGE
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State | MA
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Zip | 01518-1216
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Country | US
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Telephone | 508-301-2933
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Fax |
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Provider Business Mailing Address
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Address Line | 68 HARRISON AVE STE 605
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City | BOSTON
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State | MA
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Zip | 02111-1929
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | MS. SADIE JOHANNA FULLAM
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Credential | CCC-SLP
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Telephone | 83-012-9335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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