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General NPI Number Information
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NPI Number | 1629690474
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Entity Type | Individual
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Provider Name | KIM ELLEN MOTYLEWSKI M.S. CCC/SLP
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Gender | Female
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Dates
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Enumeration Date | 05/15/2020
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Last Update Date | 05/15/2020
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Provider Practice Location Address
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Address Line | 1 TRAFALGAR SQ STE 204
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City | NASHUA
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State | NH
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Zip | 03063-1998
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Country | US
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Telephone | 603-577-5517
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Fax |
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Provider Business Mailing Address
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Address Line | 39 MAGAZINE ST
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City | CAMBRIDGE
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State | MA
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Zip | 02139-3909
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Country | US
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Telephone | 617-710-6066
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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 | 1987
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License Number State | NH
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