Healthcare Provider Details

I. General information

NPI: 1548164320
Provider Name (Legal Business Name): MAINELY MEMORY FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 MAIN ST
DAMARISCOTTA ME
04543-4649
US

IV. Provider business mailing address

157 MAIN ST STE KB5
DAMARISCOTTA ME
04543-4649
US

V. Phone/Fax

Practice location:
  • Phone: 207-240-4112
  • Fax: 207-512-1473
Mailing address:
  • Phone: 207-240-4112
  • Fax: 207-512-1473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: JENNIFER H BRYCE
Title or Position: FOUNDER
Credential: SLP
Phone: 207-240-4112