Healthcare Provider Details

I. General information

NPI: 1609912575
Provider Name (Legal Business Name): KELI MARIE STANDER MA CCCSLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 BAXTER BLVD NORTHEAST HEARING SPEECH CENTER INC
PORTLAND ME
04101-1823
US

IV. Provider business mailing address

43 BAXTER BLVD NORTHEAST HEARING SPEECH CENTER INC
PORTLAND ME
04101-1823
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 TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberJP1611
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: