Provider Demographics
NPI:1700295847
Name:DEMARIS, ALISE REBECCA
Entity Type:Individual
Prefix:MRS
First Name:ALISE
Middle Name:REBECCA
Last Name:DEMARIS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ALISE
Other - Middle Name:REBECCA
Other - Last Name:RANALLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:94 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUXTON
Mailing Address - State:ME
Mailing Address - Zip Code:04093-6105
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 SACO RD
Practice Address - Street 2:
Practice Address - City:STANDISH
Practice Address - State:ME
Practice Address - Zip Code:04084-6240
Practice Address - Country:US
Practice Address - Phone:207-929-3840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-02
Last Update Date:2014-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEST2357235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist