Provider Demographics
NPI:1578219523
Name:JANDREAU, EMMA MARTINA
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:MARTINA
Last Name:JANDREAU
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 1:80 WEBSTER AVE
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5859
Mailing Address - Country:US
Mailing Address - Phone:120-722-7289
Mailing Address - Fax:
Practice Address - Street 1:100 MOOSEHEAD BLVD
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-2367
Practice Address - Country:US
Practice Address - Phone:207-941-6240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist