Provider Demographics
NPI:1811108798
Name:ST PETER, CARRIE LEE (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:LEE
Last Name:ST PETER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 W PRESQUE ISLE RD
Mailing Address - Street 2:
Mailing Address - City:CARIBOU
Mailing Address - State:ME
Mailing Address - Zip Code:04736-4108
Mailing Address - Country:US
Mailing Address - Phone:207-493-3399
Mailing Address - Fax:207-493-3390
Practice Address - Street 1:713 MAIN ST
Practice Address - Street 2:
Practice Address - City:CARIBOU
Practice Address - State:ME
Practice Address - Zip Code:04736-4468
Practice Address - Country:US
Practice Address - Phone:207-493-3399
Practice Address - Fax:207-493-3390
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEST1657235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME4318232999Medicaid
ME135110000Medicaid