Provider Demographics
NPI:1285825422
Name:HARRIMAN, LAURIE A (MA SLP-CCC)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:A
Last Name:HARRIMAN
Suffix:
Gender:F
Credentials:MA SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 JACOBS WAY
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038-4100
Mailing Address - Country:US
Mailing Address - Phone:207-356-9537
Mailing Address - Fax:
Practice Address - Street 1:25 JACOBS WAY
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-4100
Practice Address - Country:US
Practice Address - Phone:207-356-9537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP1826235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME435125000Medicaid