Provider Demographics
NPI:1982838132
Name:CONGDON, PRISCILLA GAIL
Entity Type:Individual
Prefix:MS
First Name:PRISCILLA
Middle Name:GAIL
Last Name:CONGDON
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 1:1107 BRISTOL RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:ME
Mailing Address - Zip Code:04539-3038
Mailing Address - Country:US
Mailing Address - Phone:207-563-1603
Mailing Address - Fax:
Practice Address - Street 1:1107 BRISTOL RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:ME
Practice Address - Zip Code:04539-3038
Practice Address - Country:US
Practice Address - Phone:207-563-1603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-03
Last Update Date:2009-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME349669222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME405480000Medicare PIN