Organization
BACK BAY SPEECH THERAPY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA BUTLER SLP (OWNER/SPEECH-LANGUAGE PATHOLOGIST)
(631) 514-5631
Entity
Organization
Contact information
Practice address
68 RUSSELL ST UNIT 4, CHARLESTOWN, MA 02129-1824
(617) 807-0516
Mailing address
68 RUSSELL ST UNIT 4, CHARLESTOWN, MA 02129-1824
(617) 807-0516
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1720360498
—
MA
Enumeration date
12/22/2018
Last updated
12/22/2018
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