Provider Demographics
NPI:1265668644
Name:SPEECH THERAPY ASSOCIATES OF MAINE
Entity Type:Organization
Organization Name:SPEECH THERAPY ASSOCIATES OF MAINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:PENELOPE
Authorized Official - Middle Name:
Authorized Official - Last Name:POLLARD
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:207-899-0383
Mailing Address - Street 1:29 DEERING ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2309
Mailing Address - Country:US
Mailing Address - Phone:207-899-0383
Mailing Address - Fax:
Practice Address - Street 1:29 DEERING ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2309
Practice Address - Country:US
Practice Address - Phone:207-899-0383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-31
Last Update Date:2009-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N/A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty