1255652244 NPI number — KIRSTEN PELTZ M.S. CCC-SLP

Table of content: KIRSTEN PELTZ M.S. CCC-SLP (NPI 1255652244)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255652244 NPI number — KIRSTEN PELTZ M.S. CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PELTZ
Provider First Name:
KIRSTEN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S. CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255652244
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/31/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 N MEADOWS RD
Provider Second Line Business Mailing Address:
SPEECH-LANGUAGE & HEARING ASSOCIATES
Provider Business Mailing Address City Name:
MEDFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02052-2317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-359-4532
Provider Business Mailing Address Fax Number:
508-359-0198

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 GREEN ST
Provider Second Line Business Practice Location Address:
WINGATE AT MELROSE
Provider Business Practice Location Address City Name:
MELROSE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02176-2811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-664-3950
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/14/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  7755 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 226538 . This is a "MEDICARE A-ORF" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: SL-M21875 . This is a "MEDICARE B" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 620733 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 626557 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: SG0013 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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