Provider Demographics
NPI:1871652990
Name:ALLEN, MARYBETH STOUT (MS CCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:MARYBETH
Middle Name:STOUT
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MS CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5724 DUNN HALL, ROOM 336
Mailing Address - Street 2:UNIVERSITY OF MAINE
Mailing Address - City:ORONO
Mailing Address - State:ME
Mailing Address - Zip Code:04469-5724
Mailing Address - Country:US
Mailing Address - Phone:207-581-2403
Mailing Address - Fax:207-581-2060
Practice Address - Street 1:5724 DUNN HALL
Practice Address - Street 2:ROOM 336 UNIVERSITY OF MAINE
Practice Address - City:ORONO
Practice Address - State:ME
Practice Address - Zip Code:04469-5724
Practice Address - Country:US
Practice Address - Phone:207-581-2403
Practice Address - Fax:207-581-2060
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP618235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME011088OtherANTHEM BCBS
ME227430099Medicaid
ME227430000Medicaid
AA24460OtherHARVARD PILGRIM
ME038288OtherANTHEM BCBS