Individual
JESSICA LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
93 SLADE ST, BELMONT, MA 02478
(310) 903-1034
Mailing address
93 SLADE ST, BELMONT, MA 02478-2225
(310) 903-1034
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP100165
MA
Other
Enumeration date
09/07/2019
Last updated
02/15/2024
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