Organization
NORTHEASTERN UNIVERSITY
Active
Parent organization
NORTHEASTERN UNIVERSITY
Other names
Speech-Language and Hearing Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
NORTHEASTERN UNIVERSITY
Authorized official
MR. SAMUEL B SOLOMON (DIRECTOR OF FINANCE AND TREASURER)
(617) 373-2597
Entity
Organization
Contact information
Practice address
30 LEON ST, 503 BEHRAKIS HEALTH SCIENCES CENTER, BOSTON, MA 02115-5009
(617) 373-2492
(671) 373-8756
Mailing address
30 LEON ST, 503 BEHRAKIS HEALTH SCIENCES CENTER, BOSTON, MA 02115-5009
(617) 373-2492
(671) 373-8756
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
4AKD
MA
235Z00000X
Speech-Language Pathologist
4AKD
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03276401
MEDICARE PTAN
MA
Enumeration date
07/24/2009
Last updated
03/01/2012
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