Provider Demographics
NPI:1326379785
Name:CORO, LINDA (SLPA)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:CORO
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 HARLOW ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-4908
Mailing Address - Country:US
Mailing Address - Phone:207-947-8493
Mailing Address - Fax:207-990-4819
Practice Address - Street 1:360 HARLOW ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4908
Practice Address - Country:US
Practice Address - Phone:207-947-8493
Practice Address - Fax:207-990-4819
Is Sole Proprietor?:No
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432342000OtherMAINECARE