Doctor Name: | ATHANASIOS VARDOULIAS |
NPI Number: | 1528401551 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.A., CCC-SLP, TSSLD |
License Number: | 019880 |
Business Practice Address: | 73 Central St Apt 3 Waltham, MA - 024535446 |
Business Phone Number: | 5166031262 |
Business Fax Number: | |
Mailing Address: | 73 Central St Apt 3, WALTHAM |
State: | MA |
Postal Code: | 024535446 |
Phone Number: | 5166031262 |
Fax Number: | |
NPI Enumeration Date: | 04/09/2013 |
NPI Last Update Date: | 10/09/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 019880 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NY |
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 |