Provider Demographics
NPI:1104306075
Name:PHIPPS, JOHN PHILIP (SLP)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:PHILIP
Last Name:PHIPPS
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:738 PEMBROKE WOODS DR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:MA
Mailing Address - Zip Code:02359-4962
Mailing Address - Country:US
Mailing Address - Phone:603-305-9177
Mailing Address - Fax:
Practice Address - Street 1:47 E GROVE ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346-1816
Practice Address - Country:US
Practice Address - Phone:781-966-5774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77034235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist