Provider Demographics
NPI:1871888065
Name:PACKARD, DEBORAH JANE
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:JANE
Last Name:PACKARD
Suffix:
Gender:F
Credentials:
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 60
Mailing Address - Street 2:
Mailing Address - City:UNITY
Mailing Address - State:ME
Mailing Address - Zip Code:04988-0060
Mailing Address - Country:US
Mailing Address - Phone:207-877-2498
Mailing Address - Fax:207-877-7458
Practice Address - Street 1:325E KENNEDY MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4531
Practice Address - Country:US
Practice Address - Phone:207-877-2498
Practice Address - Fax:207-877-7458
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP2203235Z00000X
MEST2084235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist