Basic Information
Provider Information
NPI: 1326352725
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AVEY
FirstName: MEGAN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: AUDIOLOGIST
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 104 ENDICOTT ST
Address2: SUITE 100
City: DANVERS
State: MA
PostalCode: 019233623
CountryCode: US
TelephoneNumber: 9787456601
FaxNumber: 9786244040
Practice Location
Address1: 104 ENDICOTT ST
Address2: SUITE 100
City: DANVERS
State: MA
PostalCode: 019233623
CountryCode: US
TelephoneNumber: 9787456601
FaxNumber: 9786244040
Other Information
ProviderEnumerationDate: 07/28/2010
LastUpdateDate: 10/18/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
231H00000XSP-1028-AUMAY Speech, Language and Hearing Service ProvidersAudiologist 

No ID Information.


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