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Individual

ROSALINE I R GRANOFF

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MA-CCC/SLP

Contact information

Practice address
1501 BEACON ST APT 706, BROOKLINE, MA 02446-4608
(617) 823-6469
Mailing address
1501 BEACON ST APT 706, BROOKLINE, MA 02446-4608

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
555
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00734962
ASHA
01
555
STATE PROFESSIONAL LICENSURE
MA
Enumeration date
01/22/2020
Last updated
01/22/2020
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