Provider Demographics
NPI:1295921922
Name:UNIVERSITY OF MAINE
Entity type:Organization
Organization Name:UNIVERSITY OF MAINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT FOR ADMINISTRATION A
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:WALDROM
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:207-581-1541
Mailing Address - Street 1:336 DUNN HALL
Mailing Address - Street 2:
Mailing Address - City:ORONO
Mailing Address - State:ME
Mailing Address - Zip Code:04469-5724
Mailing Address - Country:US
Mailing Address - Phone:207-581-2006
Mailing Address - Fax:207-581-2060
Practice Address - Street 1:5724 DUNN HALL
Practice Address - Street 2:ROOM 336 UNIVERSITY OF MAINE
Practice Address - City:ORONO
Practice Address - State:ME
Practice Address - Zip Code:04469-5724
Practice Address - Country:US
Practice Address - Phone:207-581-2006
Practice Address - Fax:207-581-2060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-17
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME2210881OtherAETNA
ME626492OtherHARVARD PILGRIM