Basic Information
| Provider Information | |||||||||
| NPI: | 1245397967 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RYANS | ||||||||
| FirstName: | SARA | ||||||||
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| Credential: | MS, CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 80 BEAUMONT ST | ||||||||
| Address2: | # 102 | ||||||||
| City: | DORCHESTER CENTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021245038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172658453 | ||||||||
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| Practice Location | |||||||||
| Address1: | 30 WARREN ST | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021353602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172543800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2007 | ||||||||
| LastUpdateDate: | 01/29/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SP-7290-SL | MA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.