Provider Demographics
NPI:1659630465
Name:MCINTIRE, NATALIE MARIE (SLPA)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:MARIE
Last Name:MCINTIRE
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:MARIE
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLPA
Mailing Address - Street 1:191 CAMDEN RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:ME
Mailing Address - Zip Code:04864-4207
Mailing Address - Country:US
Mailing Address - Phone:207-273-8100
Mailing Address - Fax:207-273-8103
Practice Address - Street 1:191 CAMDEN RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:ME
Practice Address - Zip Code:04864-4207
Practice Address - Country:US
Practice Address - Phone:207-273-8100
Practice Address - Fax:207-273-8103
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESAS21712355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant