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Organization

CHMC OTOLARYNGOLOGIC FOUNDATION, INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KATHLEEN M HICKEY (PROVIDER ENROLLMENT MANAGER)
(617) 355-4956
Entity
Organization

Contact information

Practice address
300 LONGWOOD AVE, BOSTON, MA 02115-5724
(617) 355-6460
(617) 730-0611
Mailing address
PO BOX 4162, WOBURN, MA 01888-4162
(617) 355-6460
(617) 730-0611

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
207Y00000X
Otolaryngology Physician
Primary
207YP0228X
Pediatric Otolaryngology Physician
231H00000X
Audiologist
235Z00000X
Speech-Language Pathologist
363AS0400X
Surgical Physician Assistant

Other

Enumeration date
10/13/2006
Last updated
12/11/2025
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