Provider Demographics
NPI:1508126749
Name:RANDLE, LAURENE P (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAURENE
Middle Name:P
Last Name:RANDLE
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:LAURENE
Other - Middle Name:
Other - Last Name:CRANFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1215
Mailing Address - Street 2:
Mailing Address - City:WELLS
Mailing Address - State:ME
Mailing Address - Zip Code:04090-1215
Mailing Address - Country:US
Mailing Address - Phone:207-641-2227
Mailing Address - Fax:207-641-2227
Practice Address - Street 1:1734 POST RD
Practice Address - Street 2:
Practice Address - City:WELLS
Practice Address - State:ME
Practice Address - Zip Code:04090-4603
Practice Address - Country:US
Practice Address - Phone:207-641-2227
Practice Address - Fax:207-641-2227
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP2156235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist