Provider Demographics
NPI:1457556318
Name:GREENBLATT, GAIL (SLP)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:GREENBLATT
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 1:10 CANDLEWYCK TER
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-1516
Mailing Address - Country:US
Mailing Address - Phone:207-771-0223
Mailing Address - Fax:207-771-0223
Practice Address - Street 1:10 CANDLEWYCK TER
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-1516
Practice Address - Country:US
Practice Address - Phone:207-771-0223
Practice Address - Fax:207-771-0223
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP285235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME017093OtherANTHEM