Provider Demographics
NPI:1861912594
Name:KADAM, MINAL ARJUN (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:MINAL
Middle Name:ARJUN
Last Name:KADAM
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 WAREHAM RD APT 2207
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-3666
Mailing Address - Country:US
Mailing Address - Phone:631-418-5501
Mailing Address - Fax:
Practice Address - Street 1:311 SERVICE RD
Practice Address - Street 2:
Practice Address - City:EAST SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02537-1370
Practice Address - Country:US
Practice Address - Phone:508-833-4131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-23
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9915235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist