Individual
JENNIFER VIDAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
5 MIDDLESEX AVE, SOMERVILLE, MA 02145-1102
(617) 591-4602
Mailing address
407 D ST UNIT 316, BOSTON, MA 02210-1943
(908) 399-6965
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
77234
MA
Other
Enumeration date
01/05/2018
Last updated
10/10/2019
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