Provider Demographics
NPI:1396845863
Name:PLUMMER, SALLY (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:PLUMMER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 WEBBS MILLS RD
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:ME
Mailing Address - Zip Code:04071-6320
Mailing Address - Country:US
Mailing Address - Phone:207-655-8672
Mailing Address - Fax:207-655-8664
Practice Address - Street 1:434 WEBBS MILLS RD
Practice Address - Street 2:
Practice Address - City:RAYMOND
Practice Address - State:ME
Practice Address - Zip Code:04071-6320
Practice Address - Country:US
Practice Address - Phone:207-655-8672
Practice Address - Fax:207-655-8664
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP892235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME045001OtherANTHEM BLUE CROSS AND BLU
ME267250099Medicaid