Provider Demographics
NPI:1275730046
Name:BREWER, TERRI W (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:W
Last Name:BREWER
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 332
Mailing Address - Street 2:7 GILMAN STREET
Mailing Address - City:MARS HILL
Mailing Address - State:ME
Mailing Address - Zip Code:04758-0332
Mailing Address - Country:US
Mailing Address - Phone:207-429-9639
Mailing Address - Fax:
Practice Address - Street 1:7 GILMAN STREET
Practice Address - Street 2:7 GILMAN STREET
Practice Address - City:MARS HILL
Practice Address - State:ME
Practice Address - Zip Code:04758-0332
Practice Address - Country:US
Practice Address - Phone:207-425-1066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP 676235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME2218331OtherAETNA PROVIDER NUMBER
ME132570000Medicaid
ME025729OtherBCBS PROVIDER NUMBER
ME132570099Medicaid