MEDICARE: WENDY GILLEN MS, 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	3078	MA

General Provider Information

NPI Number	:	1134538788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY GILLEN MS, CCC-SLP

Provider Business Mailing Address
First Line	:	169 LINCOLN ST
Second Line	:	SUITE 202
City	:	HINGHAM
State	:	MA
Zip	:	02043-4640
Country	:	US
Telephone Number	:	617-840-5445
Fax Number	:	781-875-3060

Provider Business Practice Location Address
First Line	:	169 LINCOLN ST
Second Line	:	SUITE 202
City	:	HINGHAM
State	:	MA
Zip	:	02043-4640
Country	:	US
Telephone Number	:	617-840-5445
Fax Number	:

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

Provider Enumeration Date	:	08/07/2014
Last Update Date	:	08/07/2014

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