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General NPI Number Information
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NPI Number | 1912437633
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Entity Type | Organization
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Legal Business Name | SOUTH COUNTY THERAPIES LLC
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Dates
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Enumeration Date | 06/14/2017
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Last Update Date | 05/08/2019
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Provider Practice Location Address
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Address Line | 176 MAIN ST STE 450
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City | SOUTHBRIDGE
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State | MA
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Zip | 01550-2565
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Country | US
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Telephone | 508-314-6647
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Fax |
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Provider Business Mailing Address
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Address Line | 64 MAIN ST
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City | STURBRIDGE
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State | MA
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Zip | 01566-1244
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Country | US
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Telephone | 774-318-1900
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Fax | 774-272-8810
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST
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Name | SHANNON SULLIVAN
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Credential | MA CCC-SLP
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Telephone | 774-318-1900
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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 | 5734
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License Number State | MA
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