Provider Demographics
NPI:1710641576
Name:LEGERE, CHRISTINE COLBY
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:COLBY
Last Name:LEGERE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 QUIET LN
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-2269
Mailing Address - Country:US
Mailing Address - Phone:207-712-5457
Mailing Address - Fax:
Practice Address - Street 1:358 MAIN ST
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-1314
Practice Address - Country:US
Practice Address - Phone:207-712-5457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist