Provider Demographics
NPI:1578861571
Name:BIRK, JANICE T (MC CCC)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:T
Last Name:BIRK
Suffix:
Gender:F
Credentials:MC CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 HEALD HWY
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:ME
Mailing Address - Zip Code:04862-3647
Mailing Address - Country:US
Mailing Address - Phone:207-785-4334
Mailing Address - Fax:
Practice Address - Street 1:1070 HEALD HWY
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:ME
Practice Address - Zip Code:04862-3647
Practice Address - Country:US
Practice Address - Phone:207-785-4334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP318235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist