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General NPI Number Information
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NPI Number | 1699659755
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Entity Type | Organization
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Legal Business Name | BLUE HERON SPEECH & LANGUAGE LLC
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Dates
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Enumeration Date | 08/02/2025
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 4213 OLD POST RD # A
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City | CHARLESTOWN
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State | RI
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Zip | 02813-2562
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Country | US
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Telephone | 401-859-2224
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Fax |
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Provider Business Mailing Address
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Address Line | 1B LAUDONE DR
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City | BRADFORD
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State | RI
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Zip | 02808-1613
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Country | US
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Telephone | 401-741-2633
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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 | MRS. GENEVIEVE GRAY MULLER
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Credential | MS CCC-SLP
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Telephone | 401-741-2633
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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 |
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License Number State |
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