Provider Demographics
NPI:1144664756
Name:VICIOSOGIORDANO, EILEEN
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:VICIOSOGIORDANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 INTERSTATE DR STE 3
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-5101
Mailing Address - Country:US
Mailing Address - Phone:413-382-7997
Mailing Address - Fax:413-382-7998
Practice Address - Street 1:171 INTERSTATE DR STE 3
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-5101
Practice Address - Country:US
Practice Address - Phone:413-382-7997
Practice Address - Fax:413-382-7998
Is Sole Proprietor?:No
Enumeration Date:2013-04-25
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist