Provider Demographics
NPI:1497060917
Name:WAKEMAN, ELENI (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ELENI
Middle Name:
Last Name:WAKEMAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 SACARAP RD
Mailing Address - Street 2:
Mailing Address - City:HARRINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04643-3224
Mailing Address - Country:US
Mailing Address - Phone:207-483-2749
Mailing Address - Fax:207-483-6051
Practice Address - Street 1:1020 SACARAP RD
Practice Address - Street 2:
Practice Address - City:HARRINGTON
Practice Address - State:ME
Practice Address - Zip Code:04643-3224
Practice Address - Country:US
Practice Address - Phone:207-483-2749
Practice Address - Fax:207-483-6051
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP589235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist