Provider Demographics
NPI:1801934534
Name:NORTHERN MAINE SPEECH LANGUAGE PATHOLOGY SERVICES, INC.
Entity type:Organization
Organization Name:NORTHERN MAINE SPEECH LANGUAGE PATHOLOGY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRISCOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-764-4498
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEE002965OtherCHAMPUS
MEE002965OtherCHAMPUS