Provider Demographics
NPI:1023123601
Name:BILLINGTON, JACQUELINE O (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:O
Last Name:BILLINGTON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 TANDBERG TRL
Mailing Address - Street 2:SUITE 7
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-6417
Mailing Address - Country:US
Mailing Address - Phone:207-893-1999
Mailing Address - Fax:207-591-4636
Practice Address - Street 1:32 TANDBERG TRL
Practice Address - Street 2:7
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-6417
Practice Address - Country:US
Practice Address - Phone:207-893-1599
Practice Address - Fax:207-878-3160
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP860235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME133870000Medicaid
ME133877099Medicaid