Provider Demographics
NPI:1679871651
Name:PHILBROOK, EMILY SUE BELLMORE
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:SUE BELLMORE
Last Name:PHILBROOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:SUE
Other - Last Name:BELLMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:36 FATHOM LN
Mailing Address - Street 2:
Mailing Address - City:OWLS HEAD
Mailing Address - State:ME
Mailing Address - Zip Code:04854-3738
Mailing Address - Country:US
Mailing Address - Phone:207-542-6363
Mailing Address - Fax:
Practice Address - Street 1:3208 CAMDEN RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:ME
Practice Address - Zip Code:04864-4124
Practice Address - Country:US
Practice Address - Phone:207-594-5076
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
MESAS20782355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant