Provider Demographics
NPI:1952111338
Name:MARICHAL, HEATHER M
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
Last Name:MARICHAL
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 1:59 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-2024
Mailing Address - Country:US
Mailing Address - Phone:207-240-0526
Mailing Address - Fax:
Practice Address - Street 1:2 PLAZA DR
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-5927
Practice Address - Country:US
Practice Address - Phone:207-893-2930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDL458237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist