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General NPI Number Information
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NPI Number | 1922102912
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Entity Type | Organization
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Legal Business Name | SOUTH EAST CENTER FOR SWALLOWING & COMMUNICATION
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Dates
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Enumeration Date | 09/11/2006
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 92 GRAPE ST UNIT 1
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City | NEW BEDFORD
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State | MA
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Zip | 02740-2143
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Country | US
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Telephone | 508-991-2332
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Fax | 508-991-8437
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Provider Business Mailing Address
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Address Line | 92 GRAPE ST UNIT 1
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City | NEW BEDFORD
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State | MA
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Zip | 02740-2143
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Country | US
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Telephone | 508-991-2332
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Fax | 508-991-8437
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. KATHLEEN LYNNE FITZGERALD
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Credential | MS CCC SLP
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Telephone | 508-991-2332
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State | MA
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Taxonomy #2
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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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