Healthcare Provider Details

I. General information

NPI: 1356684831
Provider Name (Legal Business Name): ELEANOR ROSE SCHWANER PIKE M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELEANOR ROSE SCHWANER

II. Dates (important events)

Enumeration Date: 04/03/2013
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 BENSTONE RD
HEBRON ME
04238-3309
US

IV. Provider business mailing address

38 BENSTONE RD
HEBRON ME
04238-3309
US

V. Phone/Fax

Practice location:
  • Phone: 207-446-5452
  • Fax:
Mailing address:
  • Phone: 207-446-5452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number07070
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202006730
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: