Provider Demographics
NPI:1689908402
Name:JEAN, FAYE B (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:FAYE
Middle Name:B
Last Name:JEAN
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 55
Mailing Address - Street 2:
Mailing Address - City:NORTH MONMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04265-0055
Mailing Address - Country:US
Mailing Address - Phone:207-933-6813
Mailing Address - Fax:207-933-6726
Practice Address - Street 1:392 US ROUTE 202
Practice Address - Street 2:
Practice Address - City:NORTH MONMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04265
Practice Address - Country:US
Practice Address - Phone:207-933-6813
Practice Address - Fax:207-933-6726
Is Sole Proprietor?:No
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP844235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME133210000Medicaid
ME022170OtherANTHEM
ME8186582OtherCIGNA