Healthcare Provider Details

I. General information

NPI: 1346169315
Provider Name (Legal Business Name): ALYSSA ANN GAGNE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 N TEMPLE ST
LEWISTON ME
04240-3350
US

IV. Provider business mailing address

487 WOODMAN HILL RD
MINOT ME
04258-5012
US

V. Phone/Fax

Practice location:
  • Phone: 207-795-4140
  • Fax:
Mailing address:
  • Phone: 207-795-4140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberST4653
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: