Provider Demographics
NPI:1376117093
Name:KENNEBEC SPEECH THERAPY PLLC
Entity Type:Organization
Organization Name:KENNEBEC SPEECH THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:REILY
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:207-931-6319
Mailing Address - Street 1:289 STANLEY RD
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:ME
Mailing Address - Zip Code:04364-3336
Mailing Address - Country:US
Mailing Address - Phone:207-931-6319
Mailing Address - Fax:
Practice Address - Street 1:5 COMMUNITY DR STE 101
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-8087
Practice Address - Country:US
Practice Address - Phone:207-931-6319
Practice Address - Fax:207-512-1727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-17
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty