| Organization Name: | WELLESLEY PEDIATRIC SPEECH LLC |
| NPI Number: | 1215242391 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | IVY KUBLIN (SOLE MBR) |
| Mailing Address: | 65 Walnut St Suite 302 Wellesley |
| State: | MA US |
| Postal Code: | 024812118 |
| Phone Number: | 7814893697 |
| Fax Number: | |
| NPI Enumeration Date: | 08/12/2010 |
| NPI Last Update Date: | 09/07/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 7659 |
| 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 |