MEDICARE: IRINA OSTROVSKAYA 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
1	235Z00000X	Speech-Language Pathologist	76783	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	76783	OTHER	MA	SPEECH-LANGUAGE PATHOLOGIST
2	14133323	OTHER		AMERICAN SPEECH HEARING ASSOCIATION - CERTIFICATE OF CLINICAL COMPETENCE

General Provider Information

NPI Number	:	1114387578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRINA OSTROVSKAYA M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	321 FORTUNE BLVD STE 202
Second Line	:
City	:	MILFORD
State	:	MA
Zip	:	01757-1750
Country	:	US
Telephone Number	:	508-478-0207
Fax Number	:	508-684-6984

Provider Business Practice Location Address
First Line	:	790 TURNPIKE ST STE 105
Second Line	:
City	:	NORTH ANDOVER
State	:	MA
Zip	:	01845-6129
Country	:	US
Telephone Number	:	508-478-0207
Fax Number	:	508-634-6984

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/29/2016
Last Update Date	:	06/06/2019

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Directions to “ IRINA OSTROVSKAYA M.S., CCC-SLP” Practice Location

Language	Start Address	Practice Location

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