Provider Demographics
NPI:1366647596
Name:JARDINE, ELIZABETH BEAL (AUD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:BEAL
Last Name:JARDINE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 BEECHLAND RD
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-2539
Mailing Address - Country:US
Mailing Address - Phone:207-664-2123
Mailing Address - Fax:207-667-0706
Practice Address - Street 1:77 BEECHLAND RD
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-2539
Practice Address - Country:US
Practice Address - Phone:207-664-2123
Practice Address - Fax:207-667-0706
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2016-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP2015237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME001826601Medicare PIN
046064Medicare PIN