Provider Demographics
NPI:1386079028
Name:MICHALAKIS, EVA (MS)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:
Last Name:MICHALAKIS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 PINCKNEY ST
Mailing Address - Street 2:2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-4437
Mailing Address - Country:US
Mailing Address - Phone:917-270-3224
Mailing Address - Fax:
Practice Address - Street 1:103 PINCKNEY ST
Practice Address - Street 2:2
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-4437
Practice Address - Country:US
Practice Address - Phone:917-270-3224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012313235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist