Provider Demographics
NPI:1437469590
Name:ATHERLEY-FAHEY, COLEEN
Entity Type:Individual
Prefix:
First Name:COLEEN
Middle Name:
Last Name:ATHERLEY-FAHEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 BETTS RD
Mailing Address - Street 2:
Mailing Address - City:ORRINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04474-3842
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:296 BETTS RD
Practice Address - Street 2:
Practice Address - City:ORRINGTON
Practice Address - State:ME
Practice Address - Zip Code:04474-3842
Practice Address - Country:US
Practice Address - Phone:207-478-8627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP1164235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist