Provider Demographics
NPI:1114683737
Name:THIBODEAU, ELIZABETH HOLLY (HIS, EDD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:HOLLY
Last Name:THIBODEAU
Suffix:
Gender:F
Credentials:HIS, EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 US ROUTE 1 STE 9
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1322
Mailing Address - Country:US
Mailing Address - Phone:207-781-7200
Mailing Address - Fax:207-781-7203
Practice Address - Street 1:251 US ROUTE 1 STE 9
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1322
Practice Address - Country:US
Practice Address - Phone:207-781-7200
Practice Address - Fax:207-781-7203
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME441237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty