Provider Demographics
NPI:1679984579
Name:MAGUIRE, AMY (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:
Last Name:MAGUIRE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 CAMBRIDGE ST
Mailing Address - Street 2:PROFESSIONAL OFFICE BUILDING, 3RD FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-3108
Mailing Address - Country:US
Mailing Address - Phone:617-726-2763
Mailing Address - Fax:617-724-0771
Practice Address - Street 1:275 CAMBRIDGE ST
Practice Address - Street 2:PROFESSIONAL OFFICE BUILDING, 3RD FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3108
Practice Address - Country:US
Practice Address - Phone:617-726-2763
Practice Address - Fax:617-724-0771
Is Sole Proprietor?:No
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9057235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist