Provider Demographics
NPI:1922538875
Name:BARRALL, JAIME L (AUD)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:L
Last Name:BARRALL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:L
Other - Last Name:WESLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:PO BOX 1599
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-1599
Mailing Address - Country:US
Mailing Address - Phone:207-404-8200
Mailing Address - Fax:207-947-0435
Practice Address - Street 1:6 TELCOM DR FL 1
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3072
Practice Address - Country:US
Practice Address - Phone:207-941-2850
Practice Address - Fax:207-941-2852
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP2692231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEAP2692OtherSTATE OF MAINE AUDIOLOGIST LICENSE