Provider Demographics
NPI:1285216515
Name:HILLSIDE SPEECH THERAPY
Entity Type:Organization
Organization Name:HILLSIDE SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:
Authorized Official - Last Name:EVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:207-218-2116
Mailing Address - Street 1:67 FOX LN
Mailing Address - Street 2:
Mailing Address - City:EDDINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04428-3104
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:67 FOX LN
Practice Address - Street 2:
Practice Address - City:EDDINGTON
Practice Address - State:ME
Practice Address - Zip Code:04428-3104
Practice Address - Country:US
Practice Address - Phone:207-218-2116
Practice Address - Fax:207-466-1029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty