Provider Demographics
NPI:1407944697
Name:DAMREN-MARSCHALL, DIANNE (SLP)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:
Last Name:DAMREN-MARSCHALL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:READFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04355-3110
Mailing Address - Country:US
Mailing Address - Phone:207-449-8006
Mailing Address - Fax:207-795-4082
Practice Address - Street 1:5 GENDRON DR
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-1048
Practice Address - Country:US
Practice Address - Phone:207-513-6352
Practice Address - Fax:207-795-4082
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP556235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME258080099Medicaid