Provider Demographics
NPI:1457572497
Name:DIHARCE, EVA A (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:A
Last Name:DIHARCE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 WADLEIGH LANE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BERWICK
Mailing Address - State:ME
Mailing Address - Zip Code:03908
Mailing Address - Country:US
Mailing Address - Phone:207-450-0581
Mailing Address - Fax:
Practice Address - Street 1:20 WADLEIGH LANE
Practice Address - Street 2:
Practice Address - City:SOUTH BERWICK
Practice Address - State:ME
Practice Address - Zip Code:03908
Practice Address - Country:US
Practice Address - Phone:207-450-0581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP806235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME66Z030444ME01OtherANTHEM PROVIDER ID NUMBER