Provider Demographics
NPI:1447567318
Name:LONGACRE, KACIE NOELLE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:KACIE
Middle Name:NOELLE
Last Name:LONGACRE
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 1:15 MEMORIAL ST
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:ME
Mailing Address - Zip Code:04250-6402
Mailing Address - Country:US
Mailing Address - Phone:207-576-5949
Mailing Address - Fax:
Practice Address - Street 1:368 MINOT AVE STE 3
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-4331
Practice Address - Country:US
Practice Address - Phone:207-333-5022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-13
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEST2032235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist