Doctor Name: | MS. JESSICA ANN KALOUSTIAN |
NPI Number: | 1619037587 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S., CCC-SLP |
License Number: | SP00649 |
Business Practice Address: | 164 Summit Ave Providence, RI - 029062853 |
Business Phone Number: | 4017935080 |
Business Fax Number: | 4017937482 |
Mailing Address: | 10 Tanglewood Ln, #608 NORTH PROVIDENCE |
State: | RI |
Postal Code: | 029048910 |
Phone Number: | 4012706231 |
Fax Number: | |
NPI Enumeration Date: | 12/11/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SP00649 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | RI |
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 |