Provider Demographics
NPI:1770621401
Name:BRISCOE, ANTHONY CALVIN (EDS,CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:CALVIN
Last Name:BRISCOE
Suffix:
Gender:M
Credentials:EDS,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:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-0308
Mailing Address - Country:US
Mailing Address - Phone:207-764-4498
Mailing Address - Fax:207-764-1912
Practice Address - Street 1:4 BLAKE ST
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-2427
Practice Address - Country:US
Practice Address - Phone:207-764-4498
Practice Address - Fax:207-764-1912
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP450235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME015558OtherANTHEM BLUE CROSS