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NPI Code Detail

MEDICARE: MRS. KRISTEN LEE TUCKER MS CCC-SLP

MEDICARE: MRS. KRISTEN LEE TUCKER 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
1235Z00000XSpeech-Language Pathologist4819MA

General Provider Information

NPI Number : 1265633093
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KRISTEN LEE TUCKER MS CCC-SLP
Provider Business Mailing Address
First Line : 114 MEADOW ST
Second Line : PO BOX 604
City : CARVER
State : MA
Zip : 02330-1523
Country : US
Telephone Number : 508-866-3307
Fax Number :
Provider Business Practice Location Address
First Line : 23 ISAAC ST
Second Line :
City : MIDDLEBORO
State : MA
Zip : 02346-2080
Country : US
Telephone Number : 508-947-9295
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/30/2007
Last Update Date : 07/08/2007

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Directions to “ MRS. KRISTEN LEE TUCKER MS CCC-SLP” Practice Location

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