Provider Demographics
NPI:1730295510
Name:MARTINDALE, SORA (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SORA
Middle Name:
Last Name:MARTINDALE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:SORA
Other - Middle Name:
Other - Last Name:STONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:222 AUBURN ST
Mailing Address - Street 2:STE. 1G
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-6004
Mailing Address - Country:US
Mailing Address - Phone:207-797-8255
Mailing Address - Fax:207-797-5560
Practice Address - Street 1:222 AUBURN ST
Practice Address - Street 2:STE. 1G
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-6004
Practice Address - Country:US
Practice Address - Phone:207-797-8255
Practice Address - Fax:207-797-5560
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP1274235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME061271OtherANTHEM BLUE CROSS AND BLU