Individual
THERESA OMALLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, CCC/SLP
Contact information
Practice address
200F MAIN ST, SUITE 144, STONEHAM, MA 02180-1619
(857) 800-6407
Mailing address
11 DEAN ST, STONEHAM, MA 02180-2508
(617) 571-4894
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3222
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01102717
ASHA
MA
Enumeration date
09/03/2016
Last updated
09/03/2016
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