Provider Demographics
NPI:1346552965
Name:ECSEL SPEECH & LANGUAGE SERVICES
Entity Type:Organization
Organization Name:ECSEL SPEECH & LANGUAGE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:MUJICA
Authorized Official - Suffix:
Authorized Official - Credentials:MA; CCC-SLP
Authorized Official - Phone:207-650-2271
Mailing Address - Street 1:41 PINE HILL RD
Mailing Address - Street 2:
Mailing Address - City:CASCO
Mailing Address - State:ME
Mailing Address - Zip Code:04015-4138
Mailing Address - Country:US
Mailing Address - Phone:207-650-2271
Mailing Address - Fax:
Practice Address - Street 1:41 PINE HILL RD
Practice Address - Street 2:
Practice Address - City:CASCO
Practice Address - State:ME
Practice Address - Zip Code:04015-4138
Practice Address - Country:US
Practice Address - Phone:207-650-2271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP795261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME101130006Medicaid