Basic Information
| Provider Information | |||||||||
| NPI: | 1144860081 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOODY-POURIAN | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | CATHERINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 77 BRUIN HILL RD | ||||||||
| Address2: | |||||||||
| City: | NORTH ANDOVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018451457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088264781 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1575 CAMBRIDGE ST | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021384308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178764344 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2020 | ||||||||
| LastUpdateDate: | 01/08/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 5190 | MA | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.