MEDICARE: ALISON MARIE GOMES

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	7100	MA

General Provider Information

NPI Number	:	1689145526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISON MARIE GOMES

Provider Business Mailing Address
First Line	:	6 ELM ST
Second Line	:
City	:	BERKLEY
State	:	MA
Zip	:	02779-1405
Country	:	US
Telephone Number	:	774-218-4128
Fax Number	:

Provider Business Practice Location Address
First Line	:	567 DARTMOUTH ST
Second Line	:
City	:	SOUTH DARTMOUTH
State	:	MA
Zip	:	02748-1826
Country	:	US
Telephone Number	:	508-997-7787
Fax Number	:

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

Provider Enumeration Date	:	12/17/2018
Last Update Date	:	12/17/2018

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