| Doctor Name: | NICOLETTA VASTA GUSTAFSON |
| NPI Number: | 1043631609 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 2676 |
| Business Practice Address: | 2 Icehouse Rd Medfield, MA - 020521555 |
| Business Phone Number: | 5082429478 |
| Business Fax Number: | 5082429489 |
| Mailing Address: | 2 Laurel Ave, WELLESLEY |
| State: | MA |
| Postal Code: | 024817523 |
| Phone Number: | 7812375585 |
| Fax Number: | 7812375633 |
| NPI Enumeration Date: | 12/30/2013 |
| NPI Last Update Date: | 12/30/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 2676 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |