Healthcare Provider Details

I. General information

NPI: 1174757991
Provider Name (Legal Business Name): FAGAN CENTER FOR COMMUNICATON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2009
Last Update Date: 05/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

985 FOREST AVE
PORTLAND ME
04103-3303
US

IV. Provider business mailing address

985 FOREST AVE
PORTLAND ME
04103-3303
US

V. Phone/Fax

Practice location:
  • Phone: 207-797-2351
  • Fax: 207-839-2197
Mailing address:
  • Phone: 207-797-2351
  • Fax: 207-839-2197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP886
License Number StateME

VIII. Authorized Official

Name: SUSAN MCKINLEY
Title or Position: BILLING MANAGER
Credential: BS
Phone: 207-939-7072