Provider Demographics
NPI:1184275919
Name:CORISH, MAEVE
Entity type:Individual
Prefix:
First Name:MAEVE
Middle Name:
Last Name:CORISH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 ADAMS ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-2995
Mailing Address - Country:US
Mailing Address - Phone:267-530-0830
Mailing Address - Fax:
Practice Address - Street 1:340 SOKOKIS TRL
Practice Address - Street 2:
Practice Address - City:EAST WATERBORO
Practice Address - State:ME
Practice Address - Zip Code:04030-5411
Practice Address - Country:US
Practice Address - Phone:267-530-0830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEST3003235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist