Healthcare Provider Details

I. General information

NPI: 1457559452
Provider Name (Legal Business Name): NORTHEAST HEARING AND SPEECH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 W COMMERCIAL ST
PORTLAND ME
04101-4797
US

IV. Provider business mailing address

75 W COMMERCIAL ST
PORTLAND ME
04101-4797
US

V. Phone/Fax

Practice location:
  • Phone: 207-874-1065
  • Fax: 207-874-1068
Mailing address:
  • Phone: 207-874-1065
  • Fax: 207-874-1068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: CAMERON GARRETT
Title or Position: CEO
Credential:
Phone: 207-874-1065