Provider Demographics
NPI:1053628768
Name:CUSTER, DEVIN BOBBI-TRACEY (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DEVIN
Middle Name:BOBBI-TRACEY
Last Name:CUSTER
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 1:37 NOTTINGHAM LANE
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04350
Mailing Address - Country:US
Mailing Address - Phone:207-740-2227
Mailing Address - Fax:
Practice Address - Street 1:28 HIGH STREET
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:ME
Practice Address - Zip Code:04357
Practice Address - Country:US
Practice Address - Phone:207-740-2227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP1665235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist