Provider Demographics
NPI:1619323805
Name:VOULGARI, DIMITRA
Entity Type:Individual
Prefix:MS
First Name:DIMITRA
Middle Name:
Last Name:VOULGARI
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:DIMITRA
Other - Middle Name:
Other - Last Name:VOULGARI-TOOTHAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:15 INDUSTRIAL PARK RD
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-1804
Mailing Address - Country:US
Mailing Address - Phone:207-284-4566
Mailing Address - Fax:207-282-4148
Practice Address - Street 1:901 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-2737
Practice Address - Country:US
Practice Address - Phone:207-284-4566
Practice Address - Fax:207-282-4148
Is Sole Proprietor?:No
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP663235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist