Healthcare Provider Details

I. General information

NPI: 1255254389
Provider Name (Legal Business Name): JENSIN MAXINE FISH MS-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 MILL ST
LISBON ME
04250-6810
US

IV. Provider business mailing address

1304 MAIN RD
PHIPPSBURG ME
04562-4911
US

V. Phone/Fax

Practice location:
  • Phone: 207-353-4132
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberST4595
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: