Provider Demographics
NPI:1952529539
Name:HATCH, JOCELYN (MA SLP)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:
Last Name:HATCH
Suffix:
Gender:F
Credentials:MA SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 FOREST AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-3323
Mailing Address - Country:US
Mailing Address - Phone:207-632-2194
Mailing Address - Fax:
Practice Address - Street 1:50 NEW PORTLAND RD
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-1542
Practice Address - Country:US
Practice Address - Phone:207-839-5757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-21
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP1786235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEST1654OtherSLP-CFY