Individual
TINA LY IM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S. CCC-SLP
Contact information
Practice address
1615 COMMONWEALTH AVE, APT. 11, BRIGHTON, MA 02135-4213
(626) 840-0010
Mailing address
1615 COMMONWEALTH AVE, APT. 11, BRIGHTON, MA 02135-4213
(626) 840-0010
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7572
MA
Other
Enumeration date
02/02/2009
Last updated
02/02/2009
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