Provider Demographics
NPI:1750418836
Name:STONE, GEORGETTE LEE (MS,, CCC-SLP)
Entity type:Individual
Prefix:
First Name:GEORGETTE
Middle Name:LEE
Last Name:STONE
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 1:94 BONNYBRIAR RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-6309
Mailing Address - Country:US
Mailing Address - Phone:207-671-6366
Mailing Address - Fax:207-767-2011
Practice Address - Street 1:153 ROUTE ONE
Practice Address - Street 2:SUITE 6
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-9302
Practice Address - Country:US
Practice Address - Phone:207-671-6366
Practice Address - Fax:207-767-2011
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP1069235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist