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NPI Code Detail

MEDICARE: CHARISA EBERT M.S., CCC-SLP

MEDICARE: CHARISA EBERT M.S., CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12355S0801XSpeech-Language Assistant2380-SP-SAMA
2235Z00000XSpeech-Language Pathologist78723-SP-SLMA

General Provider Information

NPI Number : 1073269213
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARISA EBERT M.S., CCC-SLP
Provider Business Mailing Address
First Line : 108 WOODSTOCK RD
Second Line :
City : ATTLEBORO
State : MA
Zip : 02703-6713
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 800 TECHNOLOGY CENTER DR STE 110
Second Line :
City : STOUGHTON
State : MA
Zip : 02072-4721
Country : US
Telephone Number : 508-838-3738
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/25/2022
Last Update Date : 11/18/2022

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Directions to “ CHARISA EBERT M.S., CCC-SLP” Practice Location

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