Provider Demographics
NPI:1083029953
Name:BEASTER, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:BEASTER
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 1:700 MOUNT HOPE AVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5691
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 MOUNT HOPE AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5691
Practice Address - Country:US
Practice Address - Phone:207-941-2952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEST2339235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist