Provider Demographics
NPI:1649411380
Name:BROWN, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:CHADBOURNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 257
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04903-0257
Mailing Address - Country:US
Mailing Address - Phone:207-872-5775
Mailing Address - Fax:207-872-6116
Practice Address - Street 1:155 KENNEDY MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-5132
Practice Address - Country:US
Practice Address - Phone:207-872-5775
Practice Address - Fax:207-872-6116
Is Sole Proprietor?:No
Enumeration Date:2009-03-10
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESAS15792355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431877799Medicaid