Provider Demographics
NPI:1356659080
Name:CASTONGUAY, MARY-ANNE JEAN (SLP)
Entity type:Individual
Prefix:MRS
First Name:MARY-ANNE
Middle Name:JEAN
Last Name:CASTONGUAY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 LEARNING LANE
Mailing Address - Street 2:RSU #9 DBA MT. BLUE REGIONAL SCHOOL DISTRICT
Mailing Address - City:FARMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04938-7039
Mailing Address - Country:US
Mailing Address - Phone:207-778-9517
Mailing Address - Fax:
Practice Address - Street 1:113 QUEBEC STREET, W.G. MALLETT SCHOOL
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938-7039
Practice Address - Country:US
Practice Address - Phone:207-778-3529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP1206235Z00000X
ME12092107235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MELICENSE NUMBER: 1209OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION
MESP1206OtherSTATE OF MAINE, BOARD OF SPEECH-LANGUAGE PATHOLOGY