Healthcare Provider Details

I. General information

NPI: 1922695899
Provider Name (Legal Business Name): MELANIE C. AHERN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2020
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 LIMERICK RD
ARUNDEL ME
04046-8158
US

IV. Provider business mailing address

9 JAYCIN CIR
WOBURN MA
01801-3907
US

V. Phone/Fax

Practice location:
  • Phone: 207-985-7861
  • Fax:
Mailing address:
  • Phone: 781-254-5277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License NumberSP3894
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: