Provider Demographics
NPI:1922146653
Name:BUCKINGHAM, VELDA L (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:VELDA
Middle Name:L
Last Name:BUCKINGHAM
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:87 HINES STREET
Mailing Address - City:WASHBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04786-0098
Mailing Address - Country:US
Mailing Address - Phone:207-764-4490
Mailing Address - Fax:207-769-2275
Practice Address - Street 1:985 SKYWAY ST
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-2081
Practice Address - Country:US
Practice Address - Phone:207-764-4490
Practice Address - Fax:207-769-2275
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
MESP680235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME265780099Medicaid
ME024240OtherANTHEM STAR #
ME265780099Medicaid