Provider Demographics
NPI:1396052536
Name:HEARN, DEMETRIA MARCIA (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:DEMETRIA
Middle Name:MARCIA
Last Name:HEARN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 CALY HOLLOW ROAD
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043
Mailing Address - Country:US
Mailing Address - Phone:207-284-4677
Mailing Address - Fax:
Practice Address - Street 1:600 LIMERICK RD
Practice Address - Street 2:
Practice Address - City:ARUNDEL
Practice Address - State:ME
Practice Address - Zip Code:04046-8501
Practice Address - Country:US
Practice Address - Phone:207-284-4677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME107235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist