1972680403 NPI number — MS. ANNE RYDER M.A. CCC-SLP

Table of content: MS. ANNE RYDER M.A. CCC-SLP (NPI 1972680403)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972680403 NPI number — MS. ANNE RYDER M.A. CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RYDER
Provider First Name:
ANNE
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.A. 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:
1972680403
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
450 LOWELL ST
Provider Second Line Business Mailing Address:
IRONSTONE FARM THERAPY
Provider Business Mailing Address City Name:
ANDOVER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01810-5305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-475-4056
Provider Business Mailing Address Fax Number:
978-475-4046

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
450 LOWELL ST
Provider Second Line Business Practice Location Address:
IRONSTONE FARM THERAPY
Provider Business Practice Location Address City Name:
ANDOVER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01810-5305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-475-4056
Provider Business Practice Location Address Fax Number:
978-475-4046
Provider Enumeration Date:
11/01/2006

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:  6762 , 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: SP0153 . This is a "BCBS SPEECH PATHOLOGIST" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 620733 . This is a "TUFTS GROUP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: SG0013 . This is a "BCBS GROUP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1942270574 . This is a "NPI GROUP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3668706 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 478889 . This is a "TUFTS INDIVIDUAL" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 626557 . This is a "HPHC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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