=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568038768
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMY KARAS SLP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/28/2021
-----------------------------------------------------
Last Update Date | 04/08/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 87 WASHINGTON ST
-----------------------------------------------------
City | BOXFORD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01921-1240
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-893-8807
-----------------------------------------------------
Fax | 978-304-3430
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 AVERILL RD
-----------------------------------------------------
City | MIDDLETON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01949-1300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-893-8807
-----------------------------------------------------
Fax | 978-304-3430
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/SPEECH LANGUAGE PATHOLOGIST
-----------------------------------------------------
Name | MRS. AMY KARAS
-----------------------------------------------------
Credential | MS, CCC/SLP
-----------------------------------------------------
Telephone | 617-893-8807
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------