Provider Demographics
NPI:1710289160
Name:PANDORA TALKS PC
Entity Type:Organization
Organization Name:PANDORA TALKS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH/LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DARCY
Authorized Official - Middle Name:WALLACE
Authorized Official - Last Name:LIBBY
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:207-443-8912
Mailing Address - Street 1:18 MILLER ST
Mailing Address - Street 2:
Mailing Address - City:WOOLWICH
Mailing Address - State:ME
Mailing Address - Zip Code:04579-4573
Mailing Address - Country:US
Mailing Address - Phone:207-443-8912
Mailing Address - Fax:207-443-8749
Practice Address - Street 1:18 MILLER ST
Practice Address - Street 2:
Practice Address - City:WOOLWICH
Practice Address - State:ME
Practice Address - Zip Code:04579-4573
Practice Address - Country:US
Practice Address - Phone:207-443-8912
Practice Address - Fax:207-443-8749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT777225X00000X
MESP1153235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME261820099Medicaid