Provider Demographics
NPI:1255647335
Name:HARVELL, BERNADETTE (L-SLP)
Entity type:Individual
Prefix:MRS
First Name:BERNADETTE
Middle Name:
Last Name:HARVELL
Suffix:
Gender:F
Credentials:L-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 SALEM RD
Mailing Address - Street 2:
Mailing Address - City:KINGFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04947-4225
Mailing Address - Country:US
Mailing Address - Phone:207-265-4132
Mailing Address - Fax:207-265-2010
Practice Address - Street 1:102 SALEM RD
Practice Address - Street 2:
Practice Address - City:KINGFIELD
Practice Address - State:ME
Practice Address - Zip Code:04947-4225
Practice Address - Country:US
Practice Address - Phone:207-265-4132
Practice Address - Fax:207-265-2010
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP444235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist