Provider Demographics
NPI:1720382971
Name:GUERETTE, PAUL
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:GUERETTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 EAGLES WAY
Mailing Address - Street 2:
Mailing Address - City:TOPSHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04086-1239
Mailing Address - Country:US
Mailing Address - Phone:207-729-2951
Mailing Address - Fax:
Practice Address - Street 1:50 REPUBLIC AVE
Practice Address - Street 2:
Practice Address - City:TOPSHAM
Practice Address - State:ME
Practice Address - Zip Code:04086-1136
Practice Address - Country:US
Practice Address - Phone:207-729-1557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP165235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist