Provider Demographics
NPI:1336455013
Name:TWB SPEECH LANGUAGE PATHOLOGY SERVICES, INC
Entity Type:Organization
Organization Name:TWB SPEECH LANGUAGE PATHOLOGY SERVICES, INC
Other - Org Name:TWB SPEECH LANGUAGE
Other - Org Type:Other Name
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:W
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:207-425-1066
Mailing Address - Street 1:7 GILMAN STREET
Mailing Address - Street 2:PO BOX 332
Mailing Address - City:MARS HILL
Mailing Address - State:ME
Mailing Address - Zip Code:04758-0332
Mailing Address - Country:US
Mailing Address - Phone:207-425-1066
Mailing Address - Fax:
Practice Address - Street 1:7 GILMAN ST
Practice Address - Street 2:
Practice Address - City:MARS HILL
Practice Address - State:ME
Practice Address - Zip Code:04758
Practice Address - Country:US
Practice Address - Phone:207-425-1066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP676235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME025729OtherBCBS
2218331OtherAETNA
ME132570000Medicaid