Doctor Name: | PHOEBE TUCKER |
NPI Number: | 1851668370 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | SLP |
License Number: | 001487 |
Business Practice Address: | 2326 E Main St Montano Assistive Technology Center Bridgeport, CT - 066101801 |
Business Phone Number: | 2033333366 |
Business Fax Number: | 2033333364 |
Mailing Address: | 2326 E Main St, Montano Assistive Technology Center BRIDGEPORT |
State: | CT |
Postal Code: | 066101801 |
Phone Number: | 2032693511 |
Fax Number: | 2032697411 |
NPI Enumeration Date: | 11/29/2011 |
NPI Last Update Date: | 11/29/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 001487 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
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 |